Ventricular Arrhythmias
Trends in Successful Ablation Sites and Outcomes of Ablation for Idiopathic Outflow Tract Ventricular Arrhythmias

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Abstract

Objectives

This study sought to examine clinical characteristics of procedural and long-term outcomes in patients undergoing catheter ablation (CA) of outflow tract ventricular arrhythmias (OT-VAs) over 16 years.

Background

CA is an effective treatment strategy for OT-VAs.

Methods

Patients undergoing CA for OT-VAs from 1999 to 2015 were divided into 3 periods: 1999 to 2004 (early), 2005 to 2010 (middle), and 2011 to 2015 (recent). Successful ablation site (right ventricular OT, aortic cusps/left ventricular OT, or coronary venous system/epicardium), VA morphology (right bundle branch block or left bundle branch block), and acute and clinical success rates were assessed.

Results

Six hundred eighty-two patients (336 female) were included (early: n = 97; middle: n = 204; recent: n = 381). Over time there was increase in use of irrigated ablation catheters and electroanatomic mapping, and more VAs were ablated from the aortic cusp/left ventricular OT or coronary venous system/epicardium (14% vs. 45% vs. 56%; p < 0.0001). Acute procedural success was achieved in 585 patients (86%) and was similar between groups (82% vs. 84% vs. 88%; p = 0.27). Clinical success was also similar between groups (86% vs. 87% vs. 88%; p = 0.94), but more patients in earlier periods required repeat ablation (18% vs. 17% vs. 9%; p = 0.02). Overall complication rate was 2% (similar between groups).

Conclusions

Over a 16-year period there was an increase in patients undergoing CA for OT-VTs, with more ablations performed at non–right ventricular outflow tract locations using electroanatomic mapping and irrigated-tip catheters. Over time, single procedure success has improved and complications have remained limited.

Key Words

catheter ablation
outflow tract
ventricular arrhythmia

Abbreviations and Acronyms

AAD
antiarrhythmic drug
AC
aortic cusp
AIV
anterior interventricular vein
CA
catheter ablation
CVS
coronary venous system
EAM
electroanatomic mapping
ECG
electrocardiogram
EPI
epicardium
GCV
great cardiac vein
ICE
intracardiac echocardiogram
LBBB
left bundle branch block
LVOT
left ventricular outflow tract
MCOT
mobile cardiac outpatient telemetry
OT
outflow tract
RBBB
right bundle branch block
RF
radiofrequency
RVOT
right ventricular outflow tract
VA
ventricular arrhythmia

Cited by (0)

This study was supported by the Pennsylvania Steel Company and the Mark S. Marchlinski EP Research Funds in Cardiac Electrophysiology at the University of Pennsylvania. Dr. Kumareswaran has been an education consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.

Drs. Hayashi and Liang contributed equally to this work and are joint first authors.