Non-fluoroscopic catheter ablation of arrhythmias with origin at the summit of the left ventricle
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Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular Summit (LVS) is challenging and requires high-dose fluoroscopy to limit vascular damage of the coronary arteries. Ionizing radiation can increase the incidence of malignancies to both patient and operator. This study describes outcomes of catheter ablation of LVS VAs using intracardiac echo-facilitated 3D electroanatomical mapping (ICE-3D) to avoid fluoroscopy.
Twenty-six patients (47 ± 17 years old; 52% males; median ejection fraction 55 ± 13%) with premature ventricular contractions or ventricular tachycardia underwent catheter ablation. VAs were localized using ICE-3D with arrhythmia foci being mapped at the LVS. Focal ablation was performed using a 3.5-mm open-irrigated, contact force sensing radiofrequency catheter.
Acute success and recurrence rates were 84% and 24%, respectively. Holter burden was significantly reduced (24 ± 15% to 1.5 ± 2%; P = 0.01) after ablation. The use of zero fluoroscopy was achieved in 100% of cases. No major complications were observed.
Zero fluoroscopy catheter ablation of LVS VAs using ICE-3D mapping is feasible and effective.
KeywordsNon-fluoroscopic ablation Intracardiac echocardiography Ventricular arrhythmia
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the institutional review board.
Each patient gave written informed consent before the procedure.
- 2.Yamada T, Lau YR, Litovsky SH, Thomas McElderry H, Doppalapudi H, Osorio J, et al. Idiopathic ventricular arrhythmias originating from the aortic root: prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation. J Am Coll Cardiol. 2008;52:139–47.CrossRefGoogle Scholar
- 3.Yamada T, Doppalapudi H, Litovsky SH, McElderry T, Neal KG. Challenging radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left ventricular summit near the left main coronary artery. Circ Arrhythm Electrophysiol. 2016;9:e004202.Google Scholar
- 5.Santangeli P, Marchlinski FE, Zado ES, Benhayon D, Hutchinson MD, Lin D, et al. Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success. Circ Arrhythm Electrophysiol. 2015;8:337–43.CrossRefGoogle Scholar
- 7.Lin CY, Chung FP, Lin YJ, Chong E, Chang SL, Lo LW, et al. Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: electrocardiographic characteristics and correlative anatomy. Heart Rhythm. 2016;13:111–21.CrossRefGoogle Scholar
- 10.Jauregui Abularach ME, Campos B, Park KM, Tschabrunn CM, Frankel DS, Park RE, et al. Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart Rhythm. 2012;9:865–73.CrossRefGoogle Scholar
- 16.Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M,Majocchi B, et al. X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory. J Am Heart Assoc. 2018;7.Google Scholar
- 18.Proietti R, Rivera S, Dussault C, Essebag V, Bernier ML, Ayala-Paredes F, et al. Intracardiac echo-facilitated 3D electroanatomical mapping of ventricular arrhythmias from the papillary muscles: assessing the 'fourth dimension' during ablation. Europace. 2017;1:21–8.Google Scholar