The application of signal average ECG in the prediction of recurrences after catheter ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Int J Cardiol. 2017 Jun 1:236:168-173. doi: 10.1016/j.ijcard.2017.01.087. Epub 2017 Jan 18.

Abstract

Background: The changes of signal averaged ECG (SAECG) in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) undergoing radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) remains unknown.

Methods: Between 2010 and 2014, a total of 81 ARVD/C patients underwent endocardial and/or epicardial RFCA for drug-refractory VAs. Seventy patients (mean age 46.2±14.1years, 37 males) achieving acute procedure success (negative inducibility) were enrolled. Baseline characteristics, non-invasive examinations and SAECG (before and 3months after RFCA) were collected retrospectively.

Results: After successful RFCA, the electrical parameters of SAECG changed in 39 patients (55.7%), including 28 patients (40%) with electrical regression (group 1), and 11 patients (15.7%) with electrical progression (group 3). Thirty-one patients (44.3%) showed no significant SAECG change (group 2). During a mean follow-up of 17.8±10.7months, 23 patients (32.9%) had VA recurrences, including 4 in group 1, 12 in group 2, and 7 in group 3. In comparisons with groups 2 and 3, group 1 patients had a significantly better VA recurrence-free survival (P=0.02). In multivariable Cox regression analysis, electrical regression was found to be associated with fewer VA recurrences (P=0.02, OR: 0.28, 95% CI: 0.10-0.83).

Conclusions: Electrical regression of SAECG after RFCA in ARVD/C was found to be associated with fewer VA recurrences.

Keywords: ARVD/C; Catheter ablation; Electrical regression; SAECG; Ventricular arrhythmia.

MeSH terms

  • Adult
  • Arrhythmogenic Right Ventricular Dysplasia / diagnosis
  • Arrhythmogenic Right Ventricular Dysplasia / physiopathology*
  • Arrhythmogenic Right Ventricular Dysplasia / surgery*
  • Catheter Ablation / adverse effects
  • Catheter Ablation / trends*
  • Cohort Studies
  • Electrocardiography / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / physiopathology*
  • Tachycardia, Ventricular / surgery*