Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Initial Human
Neal K Bhatia1, Rim N Halaby2, Christopher G Bruce2
1Emory University, Atlanta, Georgia, USA.
Background:
Catheter ablation for ventricular arrhythmias is limited by a high first-attempt failure rate approaching 50% to 60%. Failure appears driven by physical inaccessibility of mapping and ablating deep intramyocardial substrate. VINTAGE (Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms) is a novel procedure to steer guidewires within the walls of the beating left ventricle (LV) from a right ventricular entry point and deliver a deep intramural ablation electrode anywhere within the LV.
Objectives:
The objective of this work is to assess the provisional safety and efficacy of VINTAGE intramyocardial navigation and ablation as first offered to patients.
Methods:
This is a retrospective review of all patients who underwent VINTAGE at Emory University in the practice of medicine for recurrent ventricular tachycardia (VT) or a high burden of premature ventricular contractions (PVC) despite prior ablation and antiarrhythmic drugs.
Results:
Thirteen patients (39% female) with a median of 2 (IQR: 1-3) prior ablations underwent VINTAGE (1 repeat, total 14 procedures), of whom 5 (39%) had VT and 8 (62%) had PVCs. Arrhythmias originated in the LV summit (n = 3), basal-lateral wall (n = 4), septum (n = 3), inferior wall (n = 1), and papillary muscles (n = 2). Technical success was 100%. At median follow-up of 150 days, clinical success by patient (reduction in VT therapy of PVC burden >80%) was 85% (100% for VT and 75% for PVC). Four of 5 (80%) of the VT cohort were free from appropriate implantable cardiac defibrillator shocks, appropriate antitachycardia pacing, or hospital admission due to recurrent VT. One suffered a nondisabling stroke and another a vascular complication.
Conclusions:
VINTAGE was effective at creating intramural ablation lesions and treating ventricular arrhythmias arising from targets traditionally considered inaccessible from the endocardium and epicardium, including infarcted myocardium.
