Key result
Over-the-wire microelectrode-guided ablation achieves ~90% success in eliminating LV summit OTVA.
Why the study?
To investigate the efficacy of the over-the-wire microelectrodes catheter in coronary venous system mapping and treatment of outflow tract ventricular arrhythmia arising near the left ventricular summit.
Does the over-the-wire microelectrodes catheter improve mapping and ablation success in patients with idiopathic outflow tract ventricular arrhythmia from the left ventricular summit?
Observational (n=62)
Does the over-the-wire microelectrodes catheter improve mapping and ablation success in patients with idiopathic outflow tract ventricular arrhythmia from the left ventricular summit?
The use of an over-the-wire microelectrodes catheter for coronary venous system mapping, particularly branch mapping, is highly effective for guiding ablation of ventricular arrhythmias arising from the left ventricular summit.
May facilitate LV summit VA ablation via coronary veins; hypothesis-generating pending randomized comparisons.
BACKGROUND: This study was aimed to investigate the efficacy of the over-the-wire (OTW) microelectrodes catheter in coronary venous system (CVS) mapping and treatment of outflow tract ventricular arrhythmia (OTVA) arising from the vicinity of the left ventricular summit (LVS). METHODS: Consecutive 62 patients with idiopathic OTVA in whom the OTW microelectrodes catheter was routinely used for CVS mapping were analyzed. CVS mapping was performed for both main trunk (from great cardiac vein to anterior interventricular vein) and branches including the annular branch or septal branch. RESULTS: The earliest activation site (EAS) was within the CVS in 21 patients. Among them, the EAS was within the main trunk of the CVS in seven (33%) and within the branch of the CVS in 14 (67%) patients. Radiofrequency catheter ablation was started at an anatomically adjacent site to the EAS, which eliminated OTVA in 16 (76%) patients (the endocardial LVOT in 10 and the aortic sinus of Valsalva in six patients). For the remaining five patients with unsuccessful catheter ablation at an anatomically adjacent site, targeted OTVA was eliminated by catheter ablation at the EAS within the CVS in two patients and by chemical ablation with ethanol injection in one patient, resulting in the overall success rate of 90% (19/21). CONCLUSION: The OTW microelectrodes-guided ablation of OTVA from the vicinity of the LVS was effective. In maximizing the efficacy of ablation, CVS branch mapping is important since the earliest activation was commonly recorded not in the main trunk but within the branch of the CVS.
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Shirai et al. (2022) conducted an observational in Idiopathic outflow tract ventricular arrhythmia (OTVA) (n=62). Over-the-wire (OTW) microelectrodes catheter was evaluated on Overall success rate of targeted OTVA elimination in patients with the earliest activation site within the coronary venous system. Over-the-wire microelectrodes-guided ablation of outflow tract ventricular arrhythmia from the vicinity of the left ventricular summit was effective, achieving an overall success rate of 90% (19/21).
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