Does Catheter ablation for Premature Ventricular Contractions remain
unsuccessful in Arrhythmogenic Right Ventricular Cardiomyopathy?
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. et. al. PVC
ablation in ARVC was previously studied by Aras D. et al and they
presented successful results.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.
Epicardial ablation with endocardial ablation has increased the chance
of success in this patient group. In addition, given that BCSD 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. And another factor,
contact force sensing plays an important role in evaluating the
effectiveness of the process. 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.