Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy: safety and feasibility

BACKGROUND Management of ventricular tachycardia (VT) in patients with hypertrophic cardiomyopathy (HCM) is challenging. OBJECTIVE The purpose of this study is to assess the value of radiofrequency catheter ablation (RFCA) for the treatment of the VTs in the setting of HCM. METHODS Twenty-two patients (18 with ICD) with HCM and multiple episodes of VTs resistant to medical therapy underwent RFCA with an open irrigation catheter. Epicardial access was obtained if required. All patients were followed for at least 1 year after RFCA. RESULTS Mean age was 50.4 +/- 15.3, and mean ejection fraction was 34.3% +/- 9.8%. RFCA was performed endocardially in all patients, while epicardial radiofrequency applications were needed in 13 patients. A previous endocardial ablation was unsuccessful in six patients. At 20 +/- 9 months of follow-up, elimination of VTs reached 73%. No major complication was observed during and after the procedures in all patients. CONCLUSION Catheter ablation of VTs in patients with hypertrophic cardiomyopathy refractory to medical therapy is safe, feasible, and successful in eliminating VT. Epicardial VT mapping and ablation should be considered as an important access option for the treatment of these patients to increase the success rate.