Catheter Ablation -> Ventricular Arrhythmias -> Ablation Techniques D-PO05 - Poster Session V (ID 39) Poster

Abstract

Background: Catheter ablation of left ventricle (LV) summit premature ventricular contractions (PVCs) is challenging as activation mapping can reveal similar activation times in different sites, suggesting an intramural origin. We have reported improved long-term outcomes using sequential ablation of all the early activation sites. Several advanced techniques (intracoronary mapping and ablation, bipolar ablation and ablation using 0.45%NS) have been proposed to eliminate these PVC.
Objective: We aimed to calculate the percentage of LV summit/intramural PVC cases requiring advanced techniques after failing conventional strategies.
Methods: We conducted a retrospective analysis of 31 patients who underwent ablation of LV summit PVC at 2 institutions. In all patients, multiple early activation sites were ablated (i.e. <-30msec). Acute and long-term success rate were analyzed.
Results: A total of 31 cases were enrolled (male: 61%; mean age: 55 ). The acute success was 90.3%. In the 3 patients (9.7%) in whom conventional ablation was unsuccessful, advanced techniques were utilized. 1 patient underwent intramyocardial mapping and ablation inside the first septal perforator artery. A second patient required bipolar radiofrequency ablation and a third one was successfully ablated using 0.45%NS. Freedom from all VT arrhythmia recurrence at 12 months was 23% for the entire cohort. No complications occurred.
Conclusion: Ablation of LV summit arrhythmias is technically difficult. Endocardial ablation of all multiple early activation sites increases the success rate of this procedure and only a small percentage of patients will require advanced mapping and ablation techniques.
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