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NON-OUTFLOW TRACT VENTRICULAR ARRHYTHMIAS: EFFICACY OF CATHETER ABLATION UTILIZING THE ELECTROANATOMIC MAPPING SYSTEM
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Abstract
Background: Outflow tract ventricular arrhythmias (OT-VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), are common in patients without structural heart disease. Radiofrequency catheter ablation under guidance of three-dimensional electroanatomic mapping (EAM) systems has demonstrated significant clinical efficacy, but data in Vietnam remain limited. Methods: We conducted a case series of 201 patients with idiopathic VT/PVCs originating from the outflow tract who underwent radiofrequency ablation guided by EAM systems (Ensite Velocity/Precision) at Cho Ray Hospital from March 2021 to December 2023. Clinical evaluation and 24-hour Holter ECG were performed before and after ablation. Results: A total of 211 VT/PVC foci were mapped and ablated. Most (83.4%) originated from the right ventricular outflow tract (RVOT) and 16.6% from the left ventricular outflow tract (LVOT). Common RVOT sites included septum, posterior, and anterior wall; while LVOT sites included the left coronary cusp and the aortomitral continuity. LVOT had earlier activation time (32.4 ± 9.5 ms vs. 38.3 ± 7.3 ms; p = 0.010), but RVOT showed higher pace-mapping accuracy (97.5% vs. 94.0%; p = 0.008). Fluoroscopy time and dose were higher in LVOT. Acute procedural success was 98.2% (RVOT) and 97.1% (LVOT). Mean PVC burden decreased from 28.3 ± 12.82% pre-procedure to 0 [0–0.04%] at 1 week and 0 [0–0.2%] at 3 months (p < 0.001). No procedural complications were recorded. Conclusion: Catheter ablation of OT-VAs using EAM-guided radiofrequency energy is a safe and highly effective treatment modality. It achieves excellent acute success rates and durable suppression of arrhythmias. These findings support broader implementation of EAM in managing idiopathic OT-VAs in Vietnam, particularly in patients without underlying structural heart disease.
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Keywords
idiopathic ventricular arrhythmia, outflow tract, catheter ablation
References
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