Background
Radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) arising from
the inaccessible basal region of the left ventricular summit (LVS) is challenging
due to proximity to coronary vessels, epicardial fat, and poor radiofrequency (RF)
delivery within the distal coronary venous system.
Objective
The purpose of this study was to describe the outcomes of an anatomic approach to
inaccessible LVS-VAs using bipolar radiofrequency (Bi-RFCA) delivered from the anatomically
adjacent left pulmonic cusp (LPC) to the opposite left ventricular outflow tract (LVOT).
Methods
Patients from 3 centers who had undergone Bi-RFCA for inaccessible LVS-VAs refractory
to conventional RFCA using an anatomic approach targeting the adjacent LPC (reversed
U approach) with catheter tip pointing inferiorly within the LPC and LVOT were reviewed.
Results
Seven patients (age 59 ± 12 years; 3 women) underwent Bi-RF from the LPC to the LVOT
for LVS-VAs after ≥1 failed conventional RFCA. Bi-RFCA (power 36 ± 7 W; duration 333
± 107 seconds) resulted in VA suppression in 5 of 7 patients. In 2 cases, Bi-RFCA
was successfully performed using dextrose 5% in water. No complications occurred.
After mean follow-up of 14 ± 6 months, no recurrent VT was documented in 2 of 2 patients
with baseline VT. Mean 84% reduction in premature ventricular contraction (PVC) burden
(31% ± 13% vs 4% ± 5% PVCs per day; P = .0027) was documented in the other patients.
Conclusion
In patients with LVS-VAs arising from the inaccessible region and refractory to conventional
RFCA, an anatomic approach using Bi-RFCA from the LPC and opposite LVOT is an effective
alternative approach.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 26, 2020
Footnotes
Dr Futyma reports 2 patent applications related to bipolar ablation and creation of a bipolar ablation device. All other authors have reported that they have no conflicts relevant to the contents of this paper to disclose.
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