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The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported.

Objectives

We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice.

Methods

Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automated-mapping system were included in this study. For LV access, transseptal and retrograde access were compared.

Results

All 32 pts (29 men, age 63 ± 15 years) underwent CA for VE (17 pts) or VT (15 pts). For mapping of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 ± 21.2 min for VE ablation and 212.0 ± 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 ± 1672 map points and annotation of 140 ± 98 automated mapping points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 ± 2.1% to 2.8 ± 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU.

Conclusion

Use of a high-resolution mapping system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal.

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Abbreviations

CA:

Catheter ablation

VT:

Ventricular tachycardia

VE:

Ventricular ectopy

BC:

Mini-basket catheter

LVEF:

Left ventricular ejection fraction

ICD:

Internal cardioverter defibrillator

LV:

Left ventricle

RV:

Right ventricle

RF:

Radiofrequency

PVS:

Programmed ventricular stimulation

FU:

Follow up

AECG:

Automated electrograms

AAD:

Antiarrhythmic drug therapy

CHF:

Congestive heart failure

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Author notes

  1. Arian Sultan and Barbara Bellmann contributed equally to this work.

Authors and Affiliations

  1. Department of Electrophysiology, University of Cologne, Kerpener Straße 62, 50937, Köln, Germany

    Arian Sultan, Barbara Bellmann, Jakob Lüker, Tobias Plenge, Jan-Hendrik van den Bruck, Karlo Filipovic, Susanne Erlhöfer, Liz Kuffer, Zeynep Arica & Daniel Steven

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  1. Arian Sultan
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  2. Barbara Bellmann
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  3. Jakob Lüker
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Contributions

Arian Sultan, MD: concept/design, data analysis/interpretation, drafting article, statistics, data collection.

Barbara Bellmann, MD: concept/design, data analysis/interpretation, drafting article, statistics, data collection.

Jakob Lüker, MD: data analysis/interpretation, critical revision of article, data collection.

Tobias Plenge, MD: critical revision of article, data collection.

Jan-Hendrik van den Bruck: critical revision of article, data collection.

Karlo Filipovic, MD: critical revision of article, data collection.

Susanne Erlhöfer, MD: critical revision of article, data collection.

Liz Kuffer, MD: critical revision of article, data collection.

Zeynep Arica: critical revision of article, data collection.

Daniel Steven, MD: concept/design, data analysis/interpretation, data collection.

Corresponding author

Correspondence to Barbara Bellmann.

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The authors declare that they have no conflict of interest.

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Highlights

- No differences were seen regarding safety, efficacy, or feasibility between a transseptal or transaortic LV access. The BC was able to reach all areas of the LV needed for CA and no complications occurred which were related to the BC.

- The use of a high-resolution mapping system for VT/VE ablation facilitates revelation of VT circuits or VE origin in the setting of challenging mapping conditions resulting in favorable acute and long-term success rates.

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Sultan, A., Bellmann, B., Lüker, J. et al. The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation. J Interv Card Electrophysiol 55, 287–295 (2019). https://doi.org/10.1007/s10840-019-00530-1

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  • DOI: https://doi.org/10.1007/s10840-019-00530-1

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