Background
The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular
arrhythmias (VAs) is challenging as activation mapping can reveal similar activation
times in different anatomical sites, suggesting an intramural origin.
Objective
We sought to assess whether in patients with intramural VAs and with multiple early
activation sites (EASs), sequential ablation of all the early EASs could improve acute
and long-term clinical outcomes.
Methods
A total of 116 patients undergoing catheter ablation for symptomatic LVOT VAs were
enrolled in this study. Thirty-nine patients (34%) were referred for a redo procedure,
whereas the remaining presented for a first procedure. Mapping was performed manually
in 86 cases (74%) and with a magnetic robotic system (Niobe, Stereotaxis, St. Louis,
MO) in the remainder of the cases.
Results
Of the 116 patients, 15 (13%) were found to have multiple sites of equally early activation.
In patients with multiple EASs, the mean pre-QRS activation time was significantly
less than in patients with a single EASs (−26 ± 3 ms vs −38 ± 6 ms; P < .005). Sequential ablation of all the EASs was possible in 14 patients (93%), resulting
in complete arrhythmia suppression. After a mean follow-up of 21 ± 5 months, all patients
with successful ablation of all multiple early EASs remained free from clinical VAs.
Conclusion
Intramural LVOT VAs manifesting with multiple EASs require ablation at all sites to
achieve acute and long-term success, particularly if none of the EASs is > -30ms pre-QRS
activation time.
Keywords
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Article info
Publication history
Published online: November 29, 2018
Footnotes
Dr Di Biase and Dr Romero have contributed equally to this work.
Dr Di Biase is a consultant to Stereotaxis, Biosense Webster, Boston Scientific, and Abbott; he has received speaker honoraria/travel support from Medtronic, Pfizer, Bristol-Myers Squibb, and Biotronik. Dr Natale is a consultant to Biosense Webster, Stereotaxis, and Abbott; she has received speaker honoraria from Medtronic, AtriCure, EpiEP, Biotronik, and Janssen. Dr Marchlinski has served as a consultant to and/or received lecture honorarium from Biosense Webster, Biotronik, Abbot, and Medtronic. The rest of the authors report no conflicts of interest.
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