Background: VT ablation has proven to benefit ARVC patients who failed medical therapy. Since the procedure is overall palliative and recurrences are not rare, the role of the 1st VT ablation (ABL₁) remains unclear and is underestimated due to data heterogeneity.
Objective: To evaluate the individual role of ABL₁ and changes across time.
Methods: We included ARVC patients who had ABL₁ in our institution since 2007 and had a follow-up ≥ 1y. Patient characteristics, procedure details, and arrhythmic outcomes were assessed before and after the procedure and compared across different time periods.
Results: 59 pts (33.3 ± 12.9yo; 56% male; RVEF= 0.38 ± 0.08) were included. ICD shock burden and AA drug changes were significantly reduced after ABL₁ (Fig 1A), with 30 (51%) pts remaining free of VT (median FU=64 [IQR 51] months); 18 (30%) pts required at least 1 redo ablation. Although epicardial ABL₁ was performed in 39 (66%) pts, endocardial ABL₁ was not associated with a worse ICD shock burden or survival rate (Fig 1B and 1C). When comparing changes over time, a trend towards an early ABL₁ was noted, as given by the gradual reduction in ICD shocks before ABL₁ (8.5 [IQR 4], before 2010, to 4 [IQR 5] shocks after 2016; p = 0.034). The use of amiodarone was reduced in 50%. A consistent rise in % of epicardial ABL₁ (from 0 [≤ 2009] to 76% [2016-2018]) and a progressive reduction in VT/ ICD shock recurrence after ABL₁ were also observed across time (Fig 1D).
Conclusion: ABL₁ was associated with a significant reduction in VT/ ICD shock burden. Technological advances and better understanding of the substrate have led to a higher number of epicardial procedures, early intervention and improved arrhythmic outcomes in the past decade.