Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias

Abstract

Background: Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the coronary ostia.

Objective: To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography.

Methods: We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted.

Results: Thirty-five patients (age 58 ± 13 years; 74% men) were referred for the ablation of VAs; 32 of 35 (91%) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83%) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 [49%]), right cusp (9 of 35 [26%]), right-left cusp junction (8 of 35 [23%]), or right-noncoronary cusp junction (1 of 35 [3%]). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days.

Conclusion: Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.

Keywords: Aortic cusp; Catheter ablation; Premature ventricular contractions; Ventricular tachycardia.