Outcomes of catheter ablation of ventricular arrhythmia originating from the left ventricular summit: A multicenter study

Abstract

Background: Catheter ablation has been considered an effective strategy for the treatment of ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS). However, the inherent complexity of the anatomy of the LVS may result in failed ablation or recurrence of VA.

Objective: The purpose of this multicenter study was investigate the procedural outcomes of ablation of LVS VA.

Methods: A total of 238 patients (54.6% men; mean age 53.2 ± 15.0 years) undergoing catheter ablation of LVS VA were included. Baseline characteristics, procedural parameters, and clinical outcomes were analyzed.

Results: Acute procedural success was achieved in 199 patients (83.6%). Initial epicardial ablation via the coronary venous system (93.8% [91/97]) or percutaneous transpericardial approach (6.2% [6/97]) achieved successful ablation in 40 of 97 patients (41.2%), and VA was eliminated by initial approaches from the aortic sinus of Valsalva or subvalvular endocardium in 68 of 139 patients (48.9%; P = .29). Multisite ablations were performed in the process of acute VA elimination in 105 patients (51.8%), and 7 complications occurred. During median follow-up of 26 (1-87) months, 82.2% of patients with acute success were free from VA recurrences, and the overall long-term success rate was 68.1%. Multisite ablation was the only independent predictor of VA recurrences.

Conclusion: Acute elimination of VA originating from the LVS could be achieved in 83.6% of patients, with 82.2% having no VA recurrences. Despite acute elimination of VA with multisite ablation, the incidence of VA recurrence still was high.

Keywords: Ablation; Left ventricular summit; Long-term follow-up; Procedural success; Ventricular arrhythmia.