Key result
Radiofrequency ablation inside the coronary venous system produced detectable late gadolinium enhancement on CMRI in 30% of patients compared to 90% for RVOT ablation.
Why the study?
Does RF ablation inside the distal CVS produce less detectable epicardial scar on CMRI compared to RVOT ablation in patients with idiopathic ventricular arrhythmias?
Cohort (n=20)
Does RF ablation inside the distal CVS produce less detectable epicardial scar on CMRI compared to RVOT ablation in patients with idiopathic ventricular arrhythmias?
Radiofrequency ablation within the coronary venous system produces less detectable myocardial scarring on CMRI than RVOT ablation, potentially explaining poorer long-term efficacy for left ventricular summit arrhythmias.
Answers are grounded in this paper and cite their sources.
May underlie reduced long-term efficacy for summit arrhythmias; leaves open prospective validation of scar extent as outcome predictor.
BACKGROUND: Radiofrequency (RF) ablation of idiopathic ventricular arrhythmias (IVA) from the coronary venous system (CVS) has been increasingly performed, but real effect of ablation lesions from CVS on epicardial myocardium has not been studied. OBJECTIVE: To compare effects of RF delivered inside the distal CVS during ablation of IVAs originating from left ventricular summit (LVS) with IVAs ablated from right ventricular outflow tract (RVOT) using cardiac magnetic resonance imaging (CMRI). METHODS: Twenty consecutive patients with IVAs who underwent acutely successful RF ablation at initial appropriate sites, i.e., distal CVS (Group 1, n = 10) or RVOT (Group 2; n = 10) were enrolled. Detailed contrast-enhanced CMRI of each patient was performed 3 months later. Presence and location of scars, distance of CVS to epicardial ventricular myocardium were measured and analyzed. RESULTS: Group 1 consisted of 10 and Group 2 consisted of 10 patients. Three months after the ablation, only three patients in Group 1 had detectable late gadolinium enhancement (LGE) on CMRI while nine out of 10 patients in Group 2 had evident LGE on CMRI (P: 0.02). The mean distance of distal CVS to epicardial anterobasal myocardium was measured to be 8.8 ± 1.6 mm in Group 1. In three cases that had detectable scar on superior anterobasal LV epicardium, the mean distance was 7.4 ± 1.1 mm. CONCLUSIONS: RF delivery inside the CVS is less likely to produce detectable LGE on CMRI compared to RVOT. This may partially explain less than ideal long-term results after ablation of LVS IVAs from within the great cardiac vein/anterior interventricular vein.
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Candemır et al. (2018) conducted a cohort in Idiopathic ventricular arrhythmias (n=20). Radiofrequency ablation inside the distal coronary venous system vs. Radiofrequency ablation from right ventricular outflow tract was evaluated on Detectable late gadolinium enhancement (LGE) on CMRI (p=0.02). Radiofrequency ablation inside the coronary venous system produced detectable late gadolinium enhancement on CMRI in 30% of patients compared to 90% for RVOT ablation.
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