Conjunction of Endocardial and Coronary Venous System Mapping to Ablate Ventricular Arrhythmias

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Idiopathic ventricular arrhythmias (VAs) with epicardial or intramural origins present significant ablation challenges.
• Endocardial ablation is often insufficient for these deep-seated arrhythmias.
• The coronary venous system (CVS) offers an alternative access route.

Purpose of the Study:

• To describe the successful ablation of left-sided VAs using the CVS.
• To evaluate the efficacy of combining CVS access with 3D electroanatomical mapping.
• To identify potential electrophysiologic markers for successful ablation within the CVS.

Main Methods:

• Radiofrequency ablation via the CVS was performed in 6 out of 84 consecutive patients with idiopathic VAs.
• Three-dimensional electroanatomical mapping and activation mapping were utilized.
• Patient records and electrophysiologic studies were reviewed for clinical characteristics.

Main Results:

• Successful ablation via the CVS was achieved in all 6 patients.
• Earliest activation sites within the CVS preceded endocardial sites (36.2 ± 5.6 ms vs. 14.2 ± 6.4 ms, p=0.02).
• Spiky, fractionated, long-duration potentials were recorded at successful ablation sites in 5 patients.

Conclusions:

• The CVS is a viable approach for ablating idiopathic VAs originating from epicardial or intramural locations.
• Integration of endocardial mapping with CVS access improves ablation success.
• Specific electrophysiologic findings, such as spiky fractionated potentials, can guide ablation targeting within the CVS.