Left-sided radiofrequency catheter ablation achieved complete procedural success and freedom from ventricular tachycardia recurrence during 20-month follow-up in all 4 treated patients.
Observational (n=28)
Yes
Does left-sided radiofrequency catheter ablation improve procedural success and prevent VT recurrence in adults with repaired Tetralogy of Fallot?
Left-sided radiofrequency catheter ablation is an effective strategy for treating ventricular tachycardia dependent on septal anatomic isthmuses in patients with repaired Tetralogy of Fallot, particularly when right-sided ablation fails due to hypertrophy or prosthetic material.
BACKGROUND: Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in repaired Tetralogy of Fallot focuses on isthmuses in the right ventricle but may be hampered by hypertrophied myocardium or prosthetic material. These patients may benefit from ablation at the left side of the ventricular septum. METHODS AND RESULTS: Records from 28 consecutive repaired Tetralogy of Fallot patients from 2 centers who underwent VT ablation were reviewed. Ablation targeted anatomic isthmuses containing VT re-entry circuits, which were identified by 3-dimensional substrate, pace, and entrainment mapping. A left-sided approach was considered beneficial if (1) right-sided RFCA failed, (2) part of the circuit was mapped to the left side, and (3) left-sided RFCA resulted in isthmus transection and prevention of VT induction. In 4 of 28 patients (52±13 years; 75% men), inducible for 1.5 (quartiles, 1.0 - 2.0) VTs (335±58 ms), left-sided RFCA was performed. In 3 patients, RFCA at aortic sites terminated VT related to a septal isthmus and prevented reinduction. In 1 patient, with prior biventricular implantable cardioverter-defibrillator, diastolic activity was recorded at the left side of the septum in proximity to the His-bundle. RFCA prevented VT reinduction with anticipated complete atrioventricular block. The left-sided approach resulted in complete procedural success (transection of anatomic isthmus and noninducibility) and freedom of VT recurrence during follow-up (20±15 months) in all patients. Right-sided RFCA failure was likely because of septal hypertrophy in 2, overlying pulmonary homograft in 1, and overlying ventricular septal defect patch in 1. CONCLUSIONS: Left-sided RFCA for VTs dependent on septal anatomic isthmuses improves ablation outcome in repaired Tetralogy of Fallot.
Kapel et al. (Sun,) conducted a observational in Ventricular tachycardia in repaired Tetralogy of Fallot (n=28). Left-sided radiofrequency catheter ablation was evaluated on Complete procedural success (transection of anatomic isthmus and noninducibility) and freedom of VT recurrence. Left-sided radiofrequency catheter ablation achieved complete procedural success and freedom from ventricular tachycardia recurrence during 20-month follow-up in all 4 treated patients.