Corresponding Author:
Erdi Babayigit, MD
Kulu State Hospital, Kulu, Konya, Turkey
Phone: + 90 332 641 61 00, Mobile phone: +90535 740 94 86
E-mail:erdibabayigit@gmail.com,
erdi.babayigit@saglik.gov.tr
Funding: None
Conflict of Interest: None
We have read with great interest the article “Efficacy of Catheter
Ablation for Premature Ventricular Contractions (PVC) in Arrhythmogenic
Right Ventricular Cardiomyopathy (ARVC)” by Assis
F.R.1 et. al and thanks for the authors for their
contribution to the literature. We would like to point out a few points
to be considered about their study.
As they have stated, the small number of patients is insufficient to
determine the exact role of PVC ablation in ARVC. However, PVC ablation
in ARVC was previously studied by Aras D. 2 et al. and
they presented successful results. Aras D. et al. showed a significant
decrease in PVC burden and improvement in ventricular tachycardia storm
in ARVC patients with endocardial and epicardial ablation in a series of
17 patients with successful catheter ablation.
In this study, we believe that the study should not be considered as
unsuccessful since 2 patients showed a decrease in PVC burden by more
than 80% and in the other three patients between 45-70%. The
demonstration of a decrease in PVC burden with catheter ablation in ARVD
patients indicates that a second ablation may increase the success rate
and decrease symptoms.
The fact that ARVC has a complex substrate and the disease can progress
is undoubtedly the most important factor in achieving the desired
success with PVC ablation. In this instance, especially epicardial
ablation with endocardial ablation has increased the chance of success
in this patient group. In addition, given that bilateral cardiac
sympathetic denervation ablation and basal heart rate are guaranteed by
ICD implantation, we think that administration of the maximum dose of
antiarrhythmic medication may create a significant improvement in these
patients. As another factor, contact force sensing plays an important
role in evaluating the effectiveness of the process.
As a result, we suggest that with the current treatment modalities, a
pharmacoablative combination therapy and re-ablation when necessary
would be appropriate for such a complicated disease.
Assis FR, Sharma A, Daimee UA, et al. Efficacy of Catheter Ablation
for Premature Ventricular Contractions in Arrhythmogenic Right
Ventricular Cardiomyopathy [published online ahead of print, 2021
Mar 30]. J Cardiovasc Electrophysiol . 2021;10.1111/jce.15025.
doi:10.1111/jce.15025
Aras D, Özcan F, Çay S, Özeke Ö, Kara M, Topaloğlu S. Endo/epicardial
ablation of ventricular arrhythmias with contact force-sensing
catheters in arrhythmogenic right ventricular
dysplasia/cardiomyopathy. Anatol J Cardiol . 2019;21(4):187-195.
doi:10.14744/AnatolJCardiol.2018.58534