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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.
摘要：
致心律失常性心肌病（ACM）是一组不是由缺血性引起的心律失常性心肌疾病，高血压，或者心脏瓣膜病.ACM的临床表现可能与扩张型心肌病的临床表现重叠，使鉴别诊断复杂化。在几个ACM中，室性心动过速（VT）已在早期观察到，不管疾病的严重程度。因此,预防室性心动过速复发可能是一项临床挑战.在室性心动过速治疗中使用抗心律失常药物（AAD）具有广泛的疗效和副作用。除了AAD，ACM和室性心律失常患者可从导管消融中获益,特别是如果它们是药物难治性的。各种类型的ACM之间的发病机制差异可导致致心律失常底物的异质性分布。非均匀消融策略，和不同的消融结果。已证明消融可有效消除致心律失常性右心室发育不良（ARVC）的室性快速性心律失常，结节病,查加斯心肌病,和Brugada综合征（BrS）。作为自然界中罕见的实体，某些形式的ACM的室性心动过速的消融只能通过病例报告报告。如淀粉样变性和左心室致密化不全。几种类型的ACM，包括ARVC,结节病,查加斯心肌病,BrS,左心室不紧密,可能在心外膜内或附近表现出病变底物，这可能是室性心律失常的原因。因此,联合心内膜和心外膜消融对于成功消融具有重要的临床意义.本文的目的是全面概述基材的特性，消融策略，以及使用心内膜和心外膜入路的各种类型的ACM的消融结果。
