Bipolar ablation involving coronary venous system for refractory left ventricular summit arrhythmias

被引：16

作者：

Enriquez, Andres ^{[1
,2
,11
]}

Hanson, Matthew ^{[2
]}

Nazer, Babak ^{[3
]}

Gibson, Douglas N. ^{[4
]}

Cano, Oscar ^{[5
]}

Tokioka, Sayuri ^{[6
]}

Fukamizu, Seiji ^{[6
]}

Millan, Pablo Sanchez ^{[7
]}

Hoyos, Carolina ^{[8
]}

Matos, Carlos ^{[8
]}

Sauer, William H. ^{[8
]}

Tedrow, Usha ^{[8
]}

Romero, Jorge ^{[8
]}

Neira, Victor ^{[2
,8
]}

Futyma, Marian ^{[9
,10
]}

Futyma, Piotr ^{[9
,10
]}

机构：

[1] Hosp Univ Penn, Sect Cardiac Electrophysiol, Philadelphia, PA USA

[2] Queens Univ, Div Cardiol, Kingston, ON, Canada

[3] Univ Washington, Div Cardiol, Seattle, WA USA

[4] Scripps Clin, Cardiac Electrophysiol, La Jolla, CA USA

[5] Hosp Univ Politecn La Fe, Div Cardiol, Valencia, Spain

[6] Tokyo Metropolitan Hiroo Gen Hosp, Dept Cardiol, Tokyo, Japan

[7] Hosp Univ Virgen de las Nieves, Serv Cardiol, Granada, Spain

[8] Harvard Med Sch, Brigham & Womens Hosp, Cardiac Arrhythmia Serv, Boston, MA USA

[9] Univ Rzeszow, Med Coll, Rzeszow, Poland

[10] St Josephs Heart Rhythm Ctr, Rzeszow, Poland

[11] Hosp Univ Penn, Sect Cardiac Electrophysiol, East Pavil,2nd Floor,3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA

来源：

HEART RHYTHM O2 | 2024年 / 5卷 / 01期

关键词：

Ablation techniques; Catheter ablation; Intramural; Mapping; Radiofrequency; Ventricular arrhythmia; RADIOFREQUENCY ABLATION; CATHETER ABLATION; DURATION; OUTCOMES;

D O I：

10.1016/j.hroo.2023.11.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Catheter ablation of premature ventricular complexes (PVCs) and ventricular tachycardia (VT) from the left ventricular summit (LVS) may require advanced ablation techniques. Bipolar ablation from the coronary veins and adjacent endocardial structures can be effective for refractory LVS arrhythmias. Objective The aim of this study was to investigate the outcomes of bipolar ablation performed between the coronary venous system and adjacent endocardial left ventricular outflow tract (LVOT) or right ventricular outflow tract (RVOT). Methods This multicenter study included consecutive patients with LVS PVC/VT who underwent bipolar ablation between the anterior interventricular vein (AIV) or great cardiac vein (GCV) and the endocardial LVOT/RVOT after failed unipolar ablation. Ablation was started with powers of 10-20 W and uptitrated to achieve an impedance drop of at least 10%. Angiography was performed in all cases to confirm a safe distance (>5 mm) of the catheter from the major coronary arteries. Results Between 2013 and 2023, bipolar radiofrequency ablation between the AIV/GCV and the adjacent LVOT/RVOT was attempted in 20 patients (4 female; age 57 +/- 16 years). Unipolar ablation from sites of early activation (AIV/GCV, LVOT, aortic cusps, RVOT) failed to effectively suppress the PVC/VT in all subjects. Bipolar ablation was delivered with a maximum power of 30 +/- 8 W and total duration of 238 +/- 217 s and led to acute PVC/VT elimination in all patients. No procedural-related complications occurred. Over a follow-up period of 30 +/- 24 months, the freedom from arrhythmia recurrence was 85% (1 recurrence in the VT group and 2 in the PVC group). PVC burden was reduced from 22% +/- 10% to 4% +/- 8% (P <.001). Conclusion In cases of LVS PVC/VT refractory to unipolar ablation, bipolar ablation between the coronary venous system and adjacent endocardial LVOT/RVOT is safe and effective if careful titration of power and intraprocedural angiography are performed to ensure a safe distance from the coronary arteries.

引用

页码：24 / 33

页数：10

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