Effectiveness and Safety of Radiofrequency Catheter Ablation Using Three-Dimensional Electroanatomic Mapping Systems in Treating Ventricular Arrhythmias: A Single-Center Prospective Cohort Study in Vietnam

Purpose: Advanced catheter ablation using three-dimensional electroanatomic mapping (EAM) has shown favorable outcomes in high-income countries, but real-world evidence from low- and middle-income settings is scarce. This study aimed to assess the clinical characteristics, procedural features, and outcomes of radiofrequency ablation using EAM in patients with ventricular tachycardia (VT) or premature ventricular contractions (PVCs) at a tertiary cardiac center in Vietnam. Methods: We analyzed 233 patients who underwent VT and PVC ablation at Cho Ray Hospital from March 2021 to December 2023. Patients were categorized into two groups based on left ventricular ejection fraction (LVEF) with the cut-off value of 50%: reduced (LVEF < 50%, n = 39) and preserved (LVEF ≥ 50%, n = 194). Data on demographics, arrhythmia burden, ablation protocol, and follow-up outcomes were collected and compared. Results: Patients with reduced LVEF more frequently presented with ventricular tachycardia (23.1% vs 6.7%, p < 0.001), ischemic heart disease (23.1% vs 7.7%, p = 0.008), and were more likely to require irrigated catheters (46.2% vs 20.1%, p = 0.001). The PVC burden prior to ablation was significantly different between groups (36.3% ± 17.2 vs 27.8% ± 12.2, p = 0.014) and patients with reduced LVEF exhibited remarkable recovery after ablation, with LVEF improving from 33.7 ± 8.1 to 55.2 ± 9.1 ( p < 0.001). The acute ablation success rate was 100% in both groups. The procedure demonstrated high levels of safety, with a non-severe complication rate of 4.7% (n = 11) and low radiation exposure (median 16 mGy [inter-quartile range: 11– 26]). Conclusion: Catheter ablation is highly effective and safe in treating ventricular arrhythmias across different LVEF, especially in ventricular arrhythmia-induced cardiomyopathy group, leading to rapid recovery of left ventricular function and reduction in arrhythmia burden. These findings provide important real-world evidence from a resource limited setting, providing multiple use of catheters and skin patches.