Key result
Radiofrequency catheter ablation in patients with discrete pre-potentials resulted in a higher rate of freedom from recurrent ventricular arrhythmias compared to those without discrete pre-potentials (94.0% vs 78.9%, p=0.027).
Why the study?
The predictability and long-term outcome of discrete pre-potentials in idiopathic ventricular arrhythmias arising from the aortic sinuses of Valsalva have not been fully identified.
Does the presence of discrete pre-potentials (DPPs) predict long-term success of ablation in patients with idiopathic ventricular arrhythmias originating from the aortic sinuses of Valsalva?
Observational (n=105)
No
Does the presence of discrete pre-potentials (DPPs) predict long-term success of ablation in patients with idiopathic ventricular arrhythmias originating from the aortic sinuses of Valsalva?
The presence of discrete pre-potentials during ablation of ventricular arrhythmias from the aortic sinuses of Valsalva is associated with a higher long-term success rate and is more common in younger patients.
Answers are grounded in this paper and cite their sources.
DPPs were associated with higher ablation success in aortic sinus VAs; hypothesis-generating and requires prospective validation.
Background: The predictability and long-term outcome of the discrete pre-potential (DPP) of idiopathic ventricular arrhythmias (VAs) arising from the aortic sinuses of Valsalva (ASV) have not been fully identified. Methods: Of 687 consecutive patients undergoing ablation of outflow tract VAs, there were 105 (15.3%) patients with VAs originating from the ASV region who were included. Detailed mapping was performed within the ASV in all patients. Electrocardiographic, electrophysiological parameters, and long-term success rate were compared between patients with and without the DPPs. Results: A DPP was recorded in 67 of 105 (63.8%) patients, including 38 left sinus of Valsalva (LSV)-VAs (38/105, 36.2%) and 29 right sinus of Valsalva (RSV)-VAs (29/105, 27.6%). The patients with DPPs had wider QRS duration (152 ± 17 vs. 145 ± 14 ms, p < 0.001). The average of earliest activation time was significantly earlier in patients with DPPs (−38.6 ± 8.5 vs. −27.7 ± 5.7 ms, p < 0.001). Mean time from the first lesion to elimination of VAs was shorter in patients with DPPs (2.3 ± 2.1 s vs. 4.9 ± 1.0 s, p < 0.001). A stepwise logistic multivariable analysis identified only younger age as a significant predictor of DPP (age ≤ 35.5 years predicted DPP with 92.9% positive predictive value). During a follow-up duration of 42.5 ± 22.3 months, 63 (94.0%) patients with DPPs and 30 (78.9%) patients without DPPs remained free of recurrent VAs ( p = 0.027). Conclusion: Discrete pre-potentials were observed in 63.8% of patients with VAs arising from the ASV. Ablation in patients with DPPs was associated with higher long-term success. DPPs were seen more commonly in younger (age ≤ 35.5 years) patients.
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Wei et al. (2021) conducted an observational in Idiopathic Ventricular Arrhythmias Originating From the Aortic Sinuses of Valsalva (n=105). Radiofrequency catheter ablation in patients with discrete pre-potentials (DPPs) vs. Radiofrequency catheter ablation in patients without discrete pre-potentials (DPPs) was evaluated on Freedom from recurrent ventricular arrhythmias (p=0.027). Radiofrequency catheter ablation in patients with discrete pre-potentials resulted in a higher rate of freedom from recurrent ventricular arrhythmias compared to those without discrete pre-potentials (94.0% vs 78.9%, p=0.027).
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