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Intracardiac Echocardiography and Coronary Angiography During Ventricular Ablation From the Aortic Cusps and

Dakota De Cecco1, Jeanne du Fay de Lavallaz1, Henry D Huang2,3

  • 1Electrophysiology Section, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.

Journal of Cardiovascular Electrophysiology
|May 26, 2026
PubMed

Insights

Catheter ablation for aortic cusp ventricular arrhythmias is effective. Adjunct imaging strategies vary, impacting procedure efficiency, but no coronary artery injury occurred in this study.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Catheter ablation effectively treats premature ventricular complexes (PVCs) and ventricular tachycardia (VT) originating from aortic cusps.
  • Ablation near coronary ostia raises concerns about potential coronary artery injury.
  • The role of adjunct imaging like intracardiac echocardiography (ICE) and coronary angiography is not fully established.

Purpose of the Study:

  • To evaluate the impact of different adjunct imaging strategies on catheter ablation of aortic cusp PVCs/VT.
  • To assess procedural efficiency and safety outcomes associated with various imaging approaches.

Main Methods:

  • Analysis of 311 ablation procedures in 290 patients across four high-volume centers.
  • Categorization of imaging strategies: no imaging, ICE only, angiography only, or combined ICE and angiography.
  • Comparison of procedure duration, fluoroscopy exposure, and acute efficacy based on imaging strategy.

Main Results:

  • Significant variability in imaging strategy use across centers.
  • Longer procedure times and greater fluoroscopy exposure were observed with combined ICE and angiography.
  • Successful acute elimination of targeted PVCs in 87% of procedures.
  • No instances of coronary artery injury were reported.

Conclusions:

  • Adjunct imaging strategies for aortic cusp/commissure PVC/VT ablation show wide inter-center variation.
  • Imaging approach significantly influences procedural efficiency and resource utilization.
  • Despite proximity to coronary ostia, catheter ablation demonstrated a safe profile regarding coronary injury.
Abstract

Keywords:
aortic cuspscatheter ablationcoronary angiographyintracardiac echocardiographyoutflow tract arrhythmiaspremature ventricular complexesventricular tachycardia

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