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 (ABL
1) remains unclear and is underestimated due to data heterogeneity.
Objective: To evaluate the individual role of ABL
1 and changes across time.
Methods: We included ARVC patients who had ABL
1 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 ABL
1 (
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 ABL
1 was performed in 39 (66%) pts, endocardial ABL
1 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 ABL
1 was noted, as given by the gradual reduction in ICD shocks before ABL
1 (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 ABL
1 (from 0 [≤ 2009] to 76% [2016-2018]) and a progressive reduction in VT/ ICD shock recurrence after ABL
1 were also observed across time (
Fig 1D).
Conclusion: ABL
1 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.