Key result
RF ablation of VPCs and LAVAs in LQTS is linked to ~105 ms shorter QTc.
Why the study?
The characteristics of the underlying substrate and the role of radiofrequency ablation in long QT syndrome had not been extensively discussed.
Does radiofrequency ablation of VPC triggers and epicardial LAVAs reduce QTc interval and prevent VT/VF recurrence in symptomatic patients with LQTS?
Observational (n=8)
Does radiofrequency ablation of VPC triggers and epicardial LAVAs reduce QTc interval and prevent VT/VF recurrence in symptomatic patients with LQTS?
Absolute Event Rate: 490% vs 594.9%
p-value: p=0.001
Radiofrequency ablation of epicardial LAVAs and VPC triggers in symptomatic LQTS patients significantly shortens the QTc interval but has a modest effect on preventing VT/VF recurrence.
Should not change LQTS practice; hypothesis-generating for ablation of VPC triggers and epicardial LAVAs.
BACKGROUND AND AIMS: Long QT syndrome (LQTS) ablation is currently limited to high-risk or refractory cases, targeting the elimination of triggers such as ventricular premature contraction (VPC). However, the characteristics of the underlying substrate and the role of radiofrequency ablation have not been extensively discussed. METHODS AND RESULTS: Eight symptomatic patients with LQTS (all women; aged 36 ± 10.2 years) underwent 3-D endocardial and epicardial mapping of triggers and/or substrates of ventricular arrhythmias. Genetic testing revealed P1093A mutations in the KCNH2 gene, H558R mutations in the SCN5A gene, and K28E mutations in the KCNH2 gene in three patients, respectively. A total of 13 VPC morphologies were identified, including five right ventricular outflow tract (RVOT) VPCs, one basal lateral RV, two from inferoapical RV, one from the lateral to annulus tricuspid, three from basal lateral LV and one from epicardial site of the lateral mitral annulus. Epicardial voltage mapping revealed moderate to extensive areas of scar and low voltage in all patients. The localized abnormal ventricular activities (LAVAs) were recorded in all patients and were successfully ablated. The corrected QT interval (QTc) shortened after the epicardial LAVA elimination (594.9 ± 85.98 ms vs. 490 ± 67.49 ms, p = 0.001). During a mean follow-up period of 288 ± 147.4 d (range 170-492 d), two patients experienced ventricular tachycardia (VT) /ventricular fibrillation (VF) recurrence. CONCLUSION: Regional and limited epicardial LAVAs could be identified in patients with LQTS. Radiofrequency ablation of VPC triggers and epicardial LAVAs had a modest effect on preventing future VT/VF recurrences.
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Yuniadi et al. (2025) conducted an observational in Long QT syndrome (LQTS) (n=8). Catheter ablation of VPC triggers and epicardial LAVAs vs. Baseline (pre-ablation) was evaluated on Corrected QT interval (QTc) (p=0.001). Radiofrequency ablation of VPC triggers and epicardial LAVAs in LQTS patients significantly shortened the QTc interval (594.9 vs 490 ms, p=0.001) with modest effect on VT/VF recurrence.
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