Endo‐epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta‐analysis

Background The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachyc...

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Published in:Journal of cardiovascular electrophysiology 2020-08, Vol.31 (8), p.2022-2031
Main Authors: Romero, Jorge, Patel, Kavisha, Briceno, David, Alviz, Isabella, Gabr, Mohamed, Diaz, Juan Carlos, Trivedi, Chintan, Mohanty, Sanghamitra, Della Rocca, Domenico, Al‐Ahmad, Amin, Yang, Ruike, Rios, Saul, Cerna, Luis, Du, Xianfeng, Tarantino, Nicola, Zhang, Xiao‐Dong, Lakkireddy, Dhanunjaya, Natale, Andrea, Di Biase, Luigi
Format: Article
Language:English
Subjects:
Ablation
arrhythmogenic right ventricular cardiomyopathy
Cardiac arrhythmia
Cardiomyopathy
endocardial ablation
endocardial‐epicardial ablation
Heart
Meta-analysis
Mortality
Systematic review
Tachycardia
Ventricle
ventricular arrhythmia recurrence
ventricular tachycardia
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Summary:Background The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. Objective The aim of this meta‐analysis is to assess the outcomes of ARVC patients undergoing combined endo‐epicardial VT ablation, as compared to endocardial ablation alone. Methods A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo‐epicardial VT ablation vs endocardial‐only VT ablation in patients with ARVC. Fixed‐Effect model was used if I2 < 25 and the Random‐Effects Model was used if I2 ≥ 25%. Results Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow‐up of 48.1 ± 21.5 months, endo‐epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45‐0.75; P 
ISSN:1045-3873
1540-8167
DOI:10.1111/jce.14593