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Arrhythmogenic Right Ventricular Cardiomyopathy With Extensive Abnormal Substrate: Is Isolation Possible?
Wu, Nan; Chen, Hongwu; Ju, Weizhu; Li, Mingfang; Gu, Kai; Wang, Zidun; Liu, Hailei; Shi, Jiaojiao; Jiang, Xiaohong; Cui, Chang; Cai, Cheng; Yang, Gang; Chen, Minglong.
Afiliación
  • Wu N; Gusu School, Nanjing Medical University, Suzhou, China.
  • Chen H; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Ju W; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Li M; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Gu K; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Wang Z; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Liu H; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Shi J; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Jiang X; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Cui C; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Cai C; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • Yang G; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: yanggang201301@163.com.
  • Chen M; Gusu School, Nanjing Medical University, Suzhou, China; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: chenminglong@njmu.edu.cn.
JACC Clin Electrophysiol ; 9(8 Pt 2): 1455-1463, 2023 08.
Article en En | MEDLINE | ID: mdl-37269285
BACKGROUND: In arrhythmogenic right ventricular cardiomyopathy (ARVC) patients with extensive right ventricular free wall (RVFW) abnormal substrate, large-area homogenization with combined epicardial and endocardial approach is time consuming and often inadequate for modification. OBJECTIVES: This study aimed to explore the feasibility and efficacy of RVFW abnormal substrate isolation in such patients to control ventricular tachycardia (VT). METHODS: Eight consecutive ARVC patients with VT who had extensive abnormal RVFW substrate were included. VT induction was performed before substrate mapping and modification. Detailed voltage mapping was done during sinus rhythm. A circumferential linear lesion was deployed along the border zone of low-voltage area on the RVFW to achieve electrical isolation. Other small areas with fractionated or late potentials were further homogenized. RESULTS: All 8 patients had RVFW endocardial low-voltage area. The entire RV low-voltage area was 113.8 ± 84.1 cm2 (49.6% ± 29.8%) and the dense scar was 59.6 ± 39.8 cm2 (25.0% ± 14.1%). Electrical isolation of abnormal substrate was achieved in 5 of 8 (62.5%) patients via endocardial approach alone and 3 of 8 (37.5%) patients via a combination of endocardial and epicardial approach. Electrical isolation was verified by slow automaticity (5 of 8, 62.5%) or RV noncapture (3 of 8, 37.5%) during high-output pacing inside the encircled area. VTs were induced in 6 patients before ablation, and all patients were rendered noninducible after ablation. During a median follow-up of 43 months (range: 24-53 months), 7 of 8 (87.5%) patients remained free of sustained VT. CONCLUSIONS: Electrical isolation of RVFW is feasible and can be the option in ARVC patients with extensive abnormal substrate.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Taquicardia Ventricular / Ablación por Catéter / Displasia Ventricular Derecha Arritmogénica Tipo de estudio: Etiology_studies Límite: Humans Idioma: En Revista: JACC Clin Electrophysiol Año: 2023 Tipo del documento: Article País de afiliación: China Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Taquicardia Ventricular / Ablación por Catéter / Displasia Ventricular Derecha Arritmogénica Tipo de estudio: Etiology_studies Límite: Humans Idioma: En Revista: JACC Clin Electrophysiol Año: 2023 Tipo del documento: Article País de afiliación: China Pais de publicación: Estados Unidos