Sequential or simultaneous unipolar radiofrequency ablation from both endocardial and epicardial sides successfully eliminated intramural LVOT VAs in all 14 cases.
Observational (n=14)
Does sequential or simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides eliminate idiopathic ventricular arrhythmias originating from intramural foci in the left ventricular outflow tract?
Sequential or simultaneous unipolar radiofrequency ablation from both endocardial and epicardial sides is effective for eliminating intramural LVOT ventricular arrhythmias.
BACKGROUNDS: Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the efficacy of sequential and simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides in treating intramural LVOT VAs. METHODS AND RESULTS: Fourteen consecutive LVOT VAs, which required sequential or simultaneous irrigated unipolar radiofrequency ablation from the endocardial and epicardial sides for their elimination, were studied. The first ablation was performed at the site with the earliest local ventricular activation and best pace map on the endocardial or epicardial side. When the first ablation was unsuccessful, the second ablation was delivered on the other surface. If this sequential unipolar ablation failed, simultaneous unipolar ablation from both sides was performed. The first ablation was performed on the epicardial side in 9 VAs and endocardial side in 5 VAs. The intramural LVOT VAs were successfully eliminated by the sequential (n=9) or simultaneous (n=5) unipolar catheter ablation. Simultaneous ablation was most likely to be required for the elimination of the VAs when the distance between the endocardial and epicardial ablation sites was >8 mm and the earliest local ventricular activation time relative to the QRS onset during the VAs of <-30 ms was recorded at those ablation sites. CONCLUSIONS: LVOT VAs originating from intramural foci could usually be eliminated by sequential unipolar radiofrequency ablation and sometimes required simultaneous ablation from both the endocardial and epicardial sides.
Yamada et al. (Sat,) conducted a observational in Idiopathic ventricular arrhythmias originating from the left ventricular outflow tract (n=14). Sequential and simultaneous unipolar radiofrequency catheter ablation was evaluated on Elimination of intramural LVOT VAs. Sequential or simultaneous unipolar radiofrequency ablation from both endocardial and epicardial sides successfully eliminated intramural LVOT VAs in all 14 cases.