Background: Radiofrequency catheter ablation is currently considered as the therapeutic option of choice in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and recurrent ventricular tachycardia (VT).
Objective: To assess the long term outcome of catheter ablation in a large cohort of patients with ARVC with electrical storm due to monomorphic VT. The specific objective was to assess the relationship between precordial QRS amplitude ratio and outcome of catheter ablation in these patients.
Methods and Results: Twenty-eight patients (19 men, age 52.3±14.2 years) underwent 48 catheter ablation procedures (range 1 – 6, six epicardial). All the clinical and non-clinical VTs were ablated successfully in 23 (82%) patients (1.7 ablation/patient). During mean follow-up of 18.7±15.1 months (range 1 – 64 months) 13 patients (46.5%) experienced VT recurrence. Age < 50 years (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.3 – 18.2, Cox-Regression-P=0.009) and ?QRSmvV1-V3/?QRSmvV1-V6 ?0.48 (OR: 4.8; 95%CI: 1.1 – 22.3, Cox-Regression-P=0.019) but not right ventricular size (P=0.26) and acute ablation outcome (unadjusted-P=0.03, adjusted-P [for age and QRS amplitude ratio]=0.22) were associated with VT recurrence during follow up.
Conclusions: Age < 50 years and ?QRSmvV1-V3/?QRSmvV1-V6 ?0.48 predicts recurrence of VT after successful radiofrequency catheter ablation of VT in patients with ARVC and electrical storm. More aggressive ablation strategies i.e. endocardial and epicardial mapping and ablation, may improve the long term outcome in these patients.