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Risk Assessment and Management of Outflow Tract Arrhythmias Refractory to Prior Treatments

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Abstract

Purpose of Review

The ventricular outflow tracts (OT) are a frequent site of origin of idiopathic premature ventricular complexes (PVC) and ventricular tachycardias (VT). Despite relatively high success rates, catheter ablation (CA) may fail to achieve long-term clinical success in some patients. In this article, we briefly review how to approach risk stratification in patients with OT PVC/VT and the methods to improve outcomes in cases that are refractory to standard ablation approaches.

Recent Findings

Risk stratification should consider the potential for malignant arrhythmic events and the occurrence of arrhythmia-induced cardiomyopathy. When standard ablation fails, advanced ablation techniques can be used to treat OT arrhythmias.

Summary

Indirect risk stratification methods can be used in patients with refractory OT PVC/VT. Novel ablation therapies, such as alcohol ablation, dispersive patch repositioning or bipolar ablation, can improve OT PVC/VT ablation outcomes.

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Authors and Affiliations

  1. Medical College, University of Rzeszów and St. Joseph’s Heart Rhythm Center, Rzeszów, Poland

    Piotr Futyma & Łukasz Zarębski

  2. Cardioangiologisches Centrum Bethanien, Frankfurt, Germany

    Shaojie Chen

  3. Division of Cardiology, Queen’s University, Kingston, Ontario, Canada

    Andres Enriquez

  4. Ordensklinikum Linz Elisabethinen, Linz, Austria

    Helmut Pürerfellner

  5. Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Pasquale Santangeli

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  1. Piotr Futyma
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Correspondence to Piotr Futyma.

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Dr. Futyma has reported patent applications related to bipolar and high-voltage ablation and has equity in CorSystem. Other authors report no conflict related to the content of the article. No funding was received.

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Futyma, P., Zarębski, Ł., Chen, S. et al. Risk Assessment and Management of Outflow Tract Arrhythmias Refractory to Prior Treatments. Curr Cardiovasc Risk Rep 17, 21–26 (2023). https://doi.org/10.1007/s12170-022-00712-z

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