Intracardiac Echocardiography and Coronary Angiography During Ventricular Ablation From the Aortic Cusps and Commissures: Marked Inter-Center Variability Without an Observed Coronary Injury Signal.

Introduction Catheter ablation of premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from the aortic cusps and commissures is effective but performed near the coronary ostia, raising concern for coronary injury. Adjunct imaging with intracardiac echocardiography (ICE) and coronary angiography is variably used, and its incremental benefit remains uncertain.Methods We analyzed 311 ablation procedures performed in 290 patients across four high-volume centers in the United States and Switzerland. Imaging strategies were categorized as no adjunct imaging, ICE only, angiography only, or combined ICE plus angiography.Results Marked inter-center variability in imaging use was observed. Procedure duration and fluoroscopy exposure differed significantly by imaging strategy and were greatest when both ICE and angiography were used (p < 0.001). Acute elimination of targeted PVCs occurred in 87% of procedures. No coronary artery injury was observed.Conclusion Adjunct imaging strategies for aortic cusp and commissure PVC/VT ablation vary widely across centers and substantially influence procedural efficiency. Despite frequent ablation near the coronary ostia, no coronary injury events were observed.