Outcomes of catheter ablation of ventricular arrhythmia originating from the left ventricular summit: A multicenter
Fa-Po Chung1, Chin-Yu Lin1, Yasuhiro Shirai2
1Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Catheter ablation effectively treats left ventricular summit (LVS) ventricular arrhythmias (VA), but recurrence remains high. Multisite ablation, while achieving acute success, is linked to increased VA recurrence rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Catheter ablation is a key treatment for ventricular arrhythmias (VA) originating from the left ventricular summit (LVS).
- The complex LVS anatomy presents challenges, potentially leading to ablation failure or VA recurrence.
Purpose of the Study:
- To investigate the procedural outcomes of catheter ablation for LVS VA in a multicenter study.
- To analyze baseline characteristics, procedural parameters, and clinical outcomes of LVS VA ablation.
Main Methods:
- A multicenter study included 238 patients undergoing catheter ablation for LVS VA.
- Data collected included patient demographics, procedural details, and short- and long-term clinical outcomes.
- Statistical analysis was performed to identify predictors of success and recurrence.
Main Results:
- Acute procedural success was achieved in 83.6% of patients.
- Initial ablation strategies from epicardial or endocardial sites showed variable success rates (41.2% vs. 48.9%).
- Multisite ablations were required in 51.8% of cases, with 7 complications reported. Long-term success was 68.1%, and multisite ablation predicted recurrence.
Conclusions:
- Catheter ablation can acutely eliminate LVS VA in most patients (83.6%), with a high rate of freedom from recurrence (82.2%).
- Despite acute success, the incidence of VA recurrence remains significant.
- Multisite ablation, while necessary for acute elimination, is an independent predictor of VA recurrence.
Background:
Catheter ablation has been considered an effective strategy for the treatment of ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS). However, the inherent complexity of the anatomy of the LVS may result in failed ablation or recurrence of VA.
Objective:
The purpose of this multicenter study was investigate the procedural outcomes of ablation of LVS VA.
Methods:
A total of 238 patients (54.6% men; mean age 53.2 ± 15.0 years) undergoing catheter ablation of LVS VA were included. Baseline characteristics, procedural parameters, and clinical outcomes were analyzed.
Results:
Acute procedural success was achieved in 199 patients (83.6%). Initial epicardial ablation via the coronary venous system (93.8% [91/97]) or percutaneous transpericardial approach (6.2% [6/97]) achieved successful ablation in 40 of 97 patients (41.2%), and VA was eliminated by initial approaches from the aortic sinus of Valsalva or subvalvular endocardium in 68 of 139 patients (48.9%; P = .29). Multisite ablations were performed in the process of acute VA elimination in 105 patients (51.8%), and 7 complications occurred. During median follow-up of 26 (1-87) months, 82.2% of patients with acute success were free from VA recurrences, and the overall long-term success rate was 68.1%. Multisite ablation was the only independent predictor of VA recurrences.
Conclusion:
Acute elimination of VA originating from the LVS could be achieved in 83.6% of patients, with 82.2% having no VA recurrences. Despite acute elimination of VA with multisite ablation, the incidence of VA recurrence still was high.
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