Key result
Fragmented antegrade Purkinje ablation for LPF-VT matches traditional ablation for VT freedom with less fascicular block.
Why the study?
Targeting fragmented antegrade Purkinje potentials during sinus rhythm is a novel approach for left posterior fascicular VT, prompting a comparison of its safety and efficacy against traditional ablation strategies.
Does FAP ablation improve procedural outcomes and reduce VT recurrence compared to traditional ablation in patients with LPF-VT?
Cohort (n=189)
Does FAP ablation improve procedural outcomes and reduce VT recurrence compared to traditional ablation in patients with LPF-VT?
Absolute Event Rate: 93.7% vs 86.2%
p-value: p=0.157
FAP ablation for LPF-VT achieves similar long-term efficacy as traditional approaches but with shorter procedure times, fewer RF applications, and a lower risk of fascicular block.
May reduce fascicular block risk while preserving VT control in LPF-VT; hypothesis-generating and requires randomized confirmation.
AIMS: Traditional ablation strategies including targeting the earliest Purkinje potential (PP) during left posterior fascicular (LPF) ventricular tachycardia (VT) or linear ablation at the middle segment of LPF during sinus rhythm are commonly used for the treatment of LPF-VT. Catheter ablation for LPF-VT targeting fragmented antegrade Purkinje (FAP) potential during sinus rhythm is a novel approach. We aimed to compare safety and efficacy of different ablation strategies (FAP ablation vs. traditional ablation) for the treatment of LPF-VT. METHODS AND RESULTS: Consecutive patients with electrocardiographically documented LPF-VT referred for catheter ablation received either FAP ablation approach or traditional ablation approach. Electrophysiological characteristics, procedural complications, and long-term clinical outcome were assessed. A total of 189 consecutive patients who underwent catheter ablation for LPF-VT were included. Fragmented antegrade Purkinje ablation was attempted in 95 patients, and traditional ablation was attempted in 94 patients. Acute ablation success with elimination of LPF-VT was achieved in all patients. Left posterior fascicular block occurred in 11 of 95 (11.6%) patients in the FAP group compared with 75 of 94 (79.8%) patients in the traditional group (P < 0.001). Fragmented antegrade Purkinje ablation was associated with significant shorter procedure time (94 ± 26 vs. 117 ± 23 min, P = 0.03) and fewer radiofrequency energy applications (4.1 ± 2.4 vs. 6.3 ± 3.5, P = 0.003) compared with the traditional group. One complete atrioventricular block and one left bundle branch block were seen in the traditional group. Over mean follow-up of 65 months, 89 (93.7%) patients in the FAP group and 81 (86.2%) patients in the traditional group remained free of recurrent VT off antiarrhythmic drugs (P = 0.157). CONCLUSION: Left posterior fascicular-ventricular tachycardia ablation utilizing FAP and traditional ablation approaches resulted in similar acute and long-term procedural outcomes. Serious His-Purkinje injury did occur infrequently during traditional ablation. The use of FAP ablation approach was associated with shorter procedure time and fewer radiofrequency energy applications, especially for non-inducible patients.
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Wei et al. (2023) conducted a cohort in Left posterior fascicular ventricular tachycardia (LPF-VT) (n=189). Fragmented antegrade Purkinje (FAP) ablation vs. Traditional ablation approach was evaluated on Freedom from recurrent VT off antiarrhythmic drugs (p=0.157). Fragmented antegrade Purkinje ablation for LPF-VT yielded similar long-term freedom from recurrent VT as traditional ablation (93.7% vs 86.2%; P=0.157) but significantly less fascicular block.
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