Abstract
Background
First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic map** system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported.
Objectives
We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice.
Methods
Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automated-map** system were included in this study. For LV access, transseptal and retrograde access were compared.
Results
All 32 pts (29 men, age 63 ± 15 years) underwent CA for VE (17 pts) or VT (15 pts). For map** of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 ± 21.2 min for VE ablation and 212.0 ± 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 ± 1672 map points and annotation of 140 ± 98 automated map** points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 ± 2.1% to 2.8 ± 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU.
Conclusion
Use of a high-resolution map** system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal.
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Abbreviations
- CA:
-
Catheter ablation
- VT:
-
Ventricular tachycardia
- VE:
-
Ventricular ectopy
- BC:
-
Mini-basket catheter
- LVEF:
-
Left ventricular ejection fraction
- ICD:
-
Internal cardioverter defibrillator
- LV:
-
Left ventricle
- RV:
-
Right ventricle
- RF:
-
Radiofrequency
- PVS:
-
Programmed ventricular stimulation
- FU:
-
Follow up
- AECG:
-
Automated electrograms
- AAD:
-
Antiarrhythmic drug therapy
- CHF:
-
Congestive heart failure
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Authors and Affiliations
Contributions
Arian Sultan, MD: concept/design, data analysis/interpretation, drafting article, statistics, data collection.
Barbara Bellmann, MD: concept/design, data analysis/interpretation, drafting article, statistics, data collection.
Jakob Lüker, MD: data analysis/interpretation, critical revision of article, data collection.
Tobias Plenge, MD: critical revision of article, data collection.
Jan-Hendrik van den Bruck: critical revision of article, data collection.
Karlo Filipovic, MD: critical revision of article, data collection.
Susanne Erlhöfer, MD: critical revision of article, data collection.
Liz Kuffer, MD: critical revision of article, data collection.
Zeynep Arica: critical revision of article, data collection.
Daniel Steven, MD: concept/design, data analysis/interpretation, data collection.
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Highlights
- No differences were seen regarding safety, efficacy, or feasibility between a transseptal or transaortic LV access. The BC was able to reach all areas of the LV needed for CA and no complications occurred which were related to the BC.
- The use of a high-resolution map** system for VT/VE ablation facilitates revelation of VT circuits or VE origin in the setting of challenging map** conditions resulting in favorable acute and long-term success rates.
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Sultan, A., Bellmann, B., Lüker, J. et al. The use of a high-resolution map** system may facilitate standard clinical practice in VE and VT ablation. J Interv Card Electrophysiol 55, 287–295 (2019). https://doi.org/10.1007/s10840-019-00530-1
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DOI: https://doi.org/10.1007/s10840-019-00530-1