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An 18-year-old male with arrhythmogenic cardiomyopathy was referred for catheter ablation of ventricular tachycardia after experiencing appropriate implantable cardioverter-defibrillator (ICD) shock. Six months prior, he had undergone uncomplicated implantation of an extravascular ICD (EV-ICD) [1].
Implantable cardioverter defibrillator (ICD) prevents sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM). Catheter ablation has been shown to effectively reduce ventricular tachycardia (VT) recurrence, yet its efficacy in patients without an ICD implantation remains uncertain.
Recent advancements in catheter ablation for structural ventricular tachycardia (VT), such as high-density mapping and cardiac imaging-based detection of target areas, have significantly improved the efficacy of ablation procedures.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease characterised by fibrofatty replacement of the ventricular myocardium due to specific mutations, leading to ventricular arrhythmias and sudden cardiac death. Additionally, the impact of sotalol and amiodarone is inconsistent with studies reporting contradictory results.
All study participants never received alcohol septal ablation or surgical myectomy during follow-up. In the subgroup with Class 3 of recommendation for implantable cardioverter defibrillator, patients with absolute LV-GLS ≤ 9% showed significantly worse prognosis than those with absolute LV-GLS > 9% (p =.002 vs -266.2;
Ablation will be performed with the use of a substrate-based approach in which the myocardial scar is mapped and ablated while the heart remains predominantly in sinus rhythm. Cardiovascular mortality, driven by sudden cardiac death, is the main reason for dying while waiting for heart transplantation (HTx).
Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. Cardiac MRI completely normal.
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