IMR Press / RCM / Volume 23 / Issue 9 / DOI: 10.31083/j.rcm2309324
Open Access Review
Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation
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1 Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
2 Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
3 Department of Medicine, Taipei Veterans General Hospital Taitung Branch, 95050 Taitung, Taiwan
4 Cardiovascular Center, Taichung Veterans General Hospital, 40705 Taichung, Taiwan
*Correspondence: marxtaiji@gmail.com (Fa-Po Chung); epsachen@ms41.hinet.net (Shih-Ann Chen)
Academic Editors: Bernard Belhassen and Konstantinos P. Letsas
Rev. Cardiovasc. Med. 2022, 23(9), 324; https://doi.org/10.31083/j.rcm2309324
Submitted: 13 June 2022 | Revised: 12 August 2022 | Accepted: 17 August 2022 | Published: 19 September 2022
(This article belongs to the Special Issue Arrhythmogenic Cardiomyopathy: Diagnosis and Therapy)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Arrhythmogenic cardiomyopathy (ACM) is a group of arrhythmogenic disorders of the myocardium that are not caused by ischemic, hypertensive, or valvular heart disease. The clinical manifestations of ACMs may overlap those of dilated cardiomyopathy, complicating the differential diagnosis. In several ACMs, ventricular tachycardia (VT) has been observed at an early stage, regardless of the severity of the disease. Therefore, preventing recurrences of VT can be a clinical challenge. There is a wide range of efficacy and side effects associated with the use of antiarrhythmic drugs (AADs) in the treatment of VT. In addition to AADs, patients with ACM and ventricular tachyarrhythmias may benefit from catheter ablation, especially if they are drug-refractory. The differences in pathogenesis between the various types of ACMs can lead to heterogeneous distributions of arrhythmogenic substrates, non-uniform ablation strategies, and distinct ablation outcomes. Ablation has been documented to be effective in eliminating ventricular tachyarrhythmias in arrhythmogenic right ventricular dysplasia (ARVC), sarcoidosis, Chagas cardiomyopathy, and Brugada syndrome (BrS). As an entity that is rare in nature, ablation for ventricular tachycardia in certain forms of ACM may only be reported through case reports, such as amyloidosis and left ventricular noncompaction. Several types of ACMs, including ARVC, sarcoidosis, Chagas cardiomyopathy, BrS, and left ventricular noncompaction, may exhibit diseased substrates within or adjacent to the epicardium that may be accountable for ventricular arrhythmogenesis. As a result, combining endocardial and epicardial ablation is of clinical importance for successful ablation. The purpose of this article is to provide a comprehensive overview of the substrate characteristics, ablation strategies, and ablation outcomes of various types of ACMs using endocardial and epicardial approaches.

Keywords
arrhythmogenic left ventricular cardiomyopathy
arrhythmogenic right ventricular cardiomyopathy
Brugada syndrome
Chagas cardiomyopathy
left ventricular noncompaction
sarcoidosis
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Funding
MOST 109-2314-B-075-075-MY3/ Ministry of Science and Technology
MOST 109-2314-B-010-058-MY2/ Ministry of Science and Technology
MOST 109-2314-B- 075-074-MY3/ Ministry of Science and Technology
MOST 109-2314-B-075-076-MY3/ Ministry of Science and Technology
107-2314-B-010-061-MY2/ Ministry of Science and Technology
MOST 106-2314-B-075- 006-MY3/ Ministry of Science and Technology
MOST 106-2314-B-010-046-MY3/ Ministry of Science and Technology
MOST 106-2314-B-075-073-MY3/ Ministry of Science and Technology
V106C-158/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V106C-104/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V107C-060/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V107C-054/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V109C-113/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V110C-116/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
V111C-159/ Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital
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