[Ventricular tachycardia ablation guided by LocaLisa system in patients with structural heart disease]
Mauricio Abello1, José L Merino, Rafael Peinado
1Unidad de Arritmias y Electrofisiología, UMQ de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Insights
The LocaLisa system shows promise for ventricular tachycardia ablation in structural heart disease patients, improving catheter accuracy without increasing procedure time. Further research is needed to confirm its benefits.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Ventricular tachycardia ablation in structural heart disease is challenging.
- Nonfluoroscopic navigation techniques aid mapping of complex arrhythmias.
- The LocaLisa system's efficacy for ventricular tachycardia ablation is unproven.
Purpose of the Study:
- To evaluate the effectiveness of the LocaLisa system for ventricular tachycardia ablation.
- To compare LocaLisa-guided ablation with conventional fluoroscopy-guided ablation.
Main Methods:
- 32 patients with structural heart disease undergoing ventricular tachycardia ablation were studied.
- 10 patients used the LocaLisa system; 22 were controls (fluoroscopy).
- Outcomes including success rate, procedure time, and fluoroscopy time were compared.
Main Results:
- Ablation success rates were similar: 75% (LocaLisa) vs. 68% (control).
- Procedure duration and fluoroscopy time did not differ significantly between groups.
- LocaLisa group showed a trend towards greater hemodynamic intolerance (42% vs. 24%) and more mapping during sinus rhythm (33% vs. 4%).
Conclusions:
- The LocaLisa system facilitates accurate catheter positioning for ventricular tachycardia ablation.
- It aids in delineating reentry circuits in patients with structural heart disease.
- The system shows potential for improving ablation outcomes in complex cases.
Introduction:
The ablation of ventricular tachycardia is limited by a number of factors that reduce the effectiveness of this intervention in patients with structural heart disease compared to other types of arrhythmia. Recent years have seen the development of several nonfluoroscopic navigation techniques that facilitate the mapping of complex arrhythmogenic substrates. One such technique, the LocaLisa system, has not previously been tested for the ablation of ventricular tachycardia.
Patients And Method:
A total of 32 patients with structural heart disease were treated at our center with ablation for sustained ventricular tachycardia. In 10 patients the LocaLisa system was used to visualize the catheters during the procedure. We compared the results in the LocaLisa group with those in a control group of 22 patients treated with conventional fluoroscopy-guided ablation.
Results:
The success rate of ablation was 75% (9/12 procedures) in the LocaLisa group and 68% (17/25 procedures) in the control group (P=NS). In the LocaLisa group, mean total duration of the procedure (243 +/- 84), duration of ablation (86 +/- 56) and fluoroscopy time (46 +/- 19) did not differ significantly from those in the control group (244 +/- 72 min, 79 +/- 58 min, and 43 +/- 27 min, respectively). In the LocaLisa group the trend toward greater hemodynamic intolerance in ventricular tachycardia approached significance (42% in the LocaLisa group vs 24% in the control group, P=.05) and the number of mapping procedures performed during sinus rhythm was significantly higher in the former (33% in the LocaLisa group vs 4% in the control group, P=.03). With the LocaLisa system it was possible to locate and reposition the ablation catheter accurately at the target endocardial sites, as confirmed by electrographic recordings and fluoroscopic verification.
Conclusions:
The LocaLisa system helps to delineate the reentry circuit and facilitates accurate catheter repositioning in patients with structural heart disease and ventricular tachycardia.
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