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Infusion Needle Radiofrequency Ablation for Treatment of Refractory Ventricular Arrhythmias
William G Stevenson1, Usha B Tedrow2, Vivek Reddy3
1Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Novel needle radiofrequency ablation effectively treats deep ventricular arrhythmias (VA) when conventional methods fail. This intramural approach offers significant arrhythmia control with acceptable procedural risk for refractory cases.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Catheter ablation is a primary treatment for drug-refractory ventricular arrhythmias (VA).
- Procedural failure often results from arrhythmias originating deep within the myocardium, inaccessible to standard approaches.
- Patients with deep-seated arrhythmias have limited therapeutic options.
Purpose of the Study:
- To evaluate the safety and efficacy of a new radiofrequency ablation catheter.
- The catheter features a 27-g needle for targeting deep, intramural arrhythmia substrates.
- Assess outcomes in patients with refractory ventricular arrhythmias.
Main Methods:
- A novel intramural needle radiofrequency ablation catheter was used.
- 31 patients with at least one failed prior ablation for ventricular tachycardia (VT) or ventricular dysfunction were enrolled.
- A median of 15 needle lesions were delivered per patient.
Main Results:
- Ablation abolished inducible VT in 73% of VT patients (19/26).
- Ambient arrhythmia was suppressed in 80% of nonsustained arrhythmia patients (4/5).
- At 6 months, 48% were free of recurrent arrhythmia, and 19% showed improvement, with low complication rates.
Conclusions:
- Intramural needle radiofrequency ablation provides significant arrhythmia control for refractory ventricular arrhythmias.
- This technique offers an acceptable procedural risk for patients unresponsive to conventional treatments.
- It represents a viable therapeutic option for deep-seated arrhythmias.
Background:
Catheter ablation is effective for eliminating most drug-refractory ventricular arrhythmias (VA). However, a major reason for procedural failure is arrhythmia originating deep within the myocardium where it is inaccessible to conventional endocardial or epicardial approaches. Affected patients have limited therapeutic options.
Objectives:
The objective of this study was to assess the safety and outcome of a novel radiofrequency ablation catheter that used an extendable/retractable 27-g needle capable of targeting deep arrhythmia (intramural) substrate.
Methods:
Patients who failed at least one prior catheter ablation procedure for sustained ventricular tachycardia (VT) or nonsustained VA with associated left ventricular dysfunction were enrolled at 3 centers. The target was sustained monomorphic VT in 26 patients, including 8 with recent VT storm or VT requiring intravenous medication, and 5 with incessant VA associated with ventricular dysfunction.
Results:
Needle ablation was performed in 31 patients (median of 2 failed prior ablation procedures; 71% nonischemic heart disease). After a median of 15 needle lesions/patient, ablation abolished at least 1 inducible VT in 19 of 26 VT patients (73%), and suppressed ambient arrhythmia in 4 of 5 nonsustained arrhythmia patients. At the 6-month follow-up, 48% of patients were free of recurrent arrhythmia and another 19% were improved. Procedure-related complications included a single pericardial effusion treated with percutaneous drainage and a left ventricular pacing lead dislodgement with no deaths.
Conclusions:
In patients with recurrent ventricular arrhythmias refractory to medications and conventional catheter ablation, intramural needle radiofrequency ablation offers significant arrhythmia control with an acceptable procedural risk.
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