Catheter Ablation -> Ventricular Arrhythmias -> Ablation Techniques D-AB07 - Alternate Techniques in Energy Sources (ID 6) Abstract Plus

D-AB07-06 - Intracardiac And Electrocardiographic Predictors Of Left Ventricular Arrhythmia Requiring Totally Endoscopic Robotic Epicardial Surgical Ablation (TERESA) (ID 747)


Background: Ventricular arrhythmias (VA) arising from the left ventricular (LV) summit are challenging, and electrocardiogram (ECG) and intracardiac electrogram (EGM) criteria for successful endocardial ablation versus adjunctive TERESA approach are not defined.
Objective: To describe criteria that may predict successful elimination of refractory VA from the LV summit with TERESA procedure.
Methods: Consecutive patients with prior failed LV summit VA ablations were referred to UChicago Center for Arrhythmia Care. In all patients mapping was performed on both the endocardium and epicardium via a 4/3.3F Guide-Tip catheter (Access Point,MN) placed within the anterior intraventricular vein (AIV). If feasible an ablation was performed endocardially. In refractory cases a totally endoscopic surgical dissection of the perivascular fat and ablation was performed within the LV summit.
Results: 37 patients were referred for refractory VA from the LV summit: 24% female, 56±15 years, EF 43 ± 11 %. 84% (n=31) had simultaneous epi-endo mapping performed via the AIV(10 TERESA , 21 endocardial procedures). Compared to endocardial ablation, TERESA patients’ ECGs had wider QRS duration, longer pseudo-delta waves, and longer R-S duration (p < 0.05). TERESA patients had earlier AIV timing compared to successful endocardial ablation patients (p=0.02). To predict requirement for TERESA, earliest AIV >-40ms had 100% PPV and 84% NPV and epi-endo activation difference >15ms had 88% PPV and 87% NPV.
Conclusion: Wider QRS, longer R-S duration and a greater epi-endo activation difference predicted patients that required TERESA to eliminate refractory LV summit VA.