Left Ventricular Entry to Reduce Brain Lesions During Catheter Ablation: A Randomized Trial

Area of Science:

• Cardiac Electrophysiology
• Neurology
• Interventional Cardiology

Background:

• Catheter ablation for ventricular arrhythmias is a growing procedure.
• A significant number of patients develop brain lesions post-ablation, often detected by MRI.
• The conventional retrograde aortic approach may lead to embolization, prompting investigation into alternative methods.

Purpose of the Study:

• To test if a transseptal puncture approach mitigates brain injury compared to the retrograde aortic approach during catheter ablation.
• To evaluate the safety and efficacy of the transseptal approach in reducing embolic events.

Main Methods:

• The TRAVERSE trial was a multicenter randomized controlled trial comparing transseptal versus retrograde aortic approaches.
• Patients with left ventricular arrhythmias undergoing ablation were randomized (1:1).
• Primary outcome was acute brain lesions on MRI; secondary outcomes included complications and neurocognitive assessments.

Main Results:

• The transseptal group showed a lower incidence of acute brain lesions (28%) compared to the retrograde aortic group (45%, P=0.036).
• No significant differences were observed in clinical complications or procedural efficacy between the groups.
• A trend towards better cognitive outcomes was noted in the transseptal group, though with significant loss to follow-up.

Conclusions:

• The transseptal approach for left ventricular catheter ablation nearly halved the risk of acute brain lesions compared to the retrograde aortic approach.
• This approach offers a potentially safer alternative without compromising procedure effectiveness.
• Findings suggest the transseptal method may reduce the risk of systemic embolic events, potentially protecting other organs.