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Ablation with zero-fluoroscopy of premature ventricular complexes from aortic sinus cusps: A single-center experience
Pablo J Sánchez-Millán1,2, Guillermo Gutiérrez-Ballesteros1,2, Manuel Molina-Lerma1,2
1Arrhythmia Unit Hospital Universitario Virgen de las Nieves Granada Spain.
Insights
Zero-fluoroscopy (ZF) catheter ablation for aortic sinus cusp premature ventricular complexes (ASC-PVC) using 3D intracardiac echocardiography integrated electroanatomical mapping is feasible, effective, and safe, avoiding traditional coronary catheterization.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Catheter ablation for premature ventricular complexes originating from the aortic sinus cusps (ASC-PVC) typically requires coronary catheterization.
- Limited data exists on zero-fluoroscopy (ZF) techniques for ASC-PVC mapping and ablation.
- Conventional methods involve localizing the coronary artery ostium (CAO) via coronary catheterization.
Purpose of the Study:
- To evaluate the efficacy and safety of a ZF approach for ASC-PVC ablation.
- To assess the utility of 3D intracardiac echocardiography integrated into an electroanatomical mapping system (ICE 3D-EAM) for guidance.
Main Methods:
- An observational study comparing a ZF group (n=10) with a control group (n=11) using conventional methods.
- Patients with ASC-PVC underwent ablation guided by ICE 3D-EAM in the ZF group.
- Clinical, efficacy, and safety outcomes were assessed acutely and at 3-month follow-up.
Main Results:
- No fluoroscopy was needed in the ZF group.
- Acute success rates were 80% for ZF versus 55% for the control group (P=.36).
- Recurrence rates were 30% in the ZF group and 27% in the control group (P=1). One non-severe complication occurred in the ZF group.
Conclusions:
- ZF catheter ablation of ASC-PVC guided by ICE 3D-EAM is a feasible and safe alternative.
- This approach demonstrates effectiveness in treating ASC-PVC without fluoroscopy.
Background:
Catheter ablation of premature ventricular complexes from aortic sinus cusps (ASC-PVC) is a complex procedure that conventionally requires coronary catheterization (CC) to localize coronary artery ostium (CAO). Little published information is available on the mapping and ablation with zero-fluoroscopy (ZF) of ASC-PVC. The aim of the study was to determine the efficacy and safety of ASC-PVC ablation with a ZF approach guided by 3D intracardiac echocardiography integration in the electroanatomical mapping system (ICE 3D-EAM).
Methods:
This observational study included one patient cohort treated conventionally and another treated with ICE 3D-EAM-guided ZF ablation. Clinical, efficacy, and safety outcomes were evaluated acutely and at 3 months follow-up.
Results:
The study included 21 patients with ASC-PVC: 10 in the ZF group (age 49 ± 16 years, 60% males) and 11 in the control group (age 47 ± 15 years, 27% males). Fluoroscopy was not required for any patient in the ZF group. Acute success was obtained in 80% of the ZF group vs 55% of the control group (P = .36). The recurrence rate was 30% in the ZF group vs 27% in the control group (P = 1). One nonsevere complication was observed in the ZF group (P = .48).
Conclusions:
ZF catheter ablation of ASC-PVC guided by ICE 3D-EAM is feasible, effective, and safe.
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