Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-24T11:10:46.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Experience of left ventricular outflow tract arrhythmia ablation in paediatric patients using limited fluoroscopy and three-dimensional mapping technique

Published online by Cambridge University Press:  01 December 2023

Şevket Ballı Open the ORCID record for Şevket Ballı [Opens in a new window] ,
Pınar Kanlıoğlu  and
Gokmen Akgun Open the ORCID record for Gokmen Akgun [Opens in a new window]
Şevket Ballı*
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
Pınar Kanlıoğlu
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
Gokmen Akgun
Affiliation:
Department of Pediatric Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
*
Corresponding author: Ş. Ballı; Email: drsevketballi@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The left ventricular outflow tract is an important source of ventricular arrhythmias. Up to one-third of all idiopathic ventricular arrhythmias in patients with structurally normal hearts may arise from this region. We would like to share the results of our left ventricular outflow tract ablation using three-dimensional mapping and limited fluoroscopy.

Materials and Methods:

This is a single-centre retrospective cohort study. Forty-six consecutive patients who underwent left ventricular outflow tract ablation procedures between January 2015 and June 2023 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy.

Results:

The study group comprised 29 males and 17 females, with a mean age of 13.4 ± 4.5 years. The most common location for arrhythmias was the left coronary cusp (n : 21). Other locations, in sequence, included the junction of the right and left coronary commissure (n : 10), right coronary cusp (n : 10), left ventricular outflow tract endocardium (n:4), aorto-mitral junction (n : 1), and great cardiac vein (n : 1). Nine of these patients had previously undergone unsuccessful right ventricular outflow tract ablation at another centre. Cryoablation was performed in three patients, irrigated radiofrequency ablation in three patients, and conventional radiofrequency ablation in the remaining patients. The acute success rate was 100%, and no recurrences were observed. The mean follow-up period was 49.6 ± 24.4 months. All patients were asymptomatic and were being followed without antiarrhythmic medication.

Conclusion:

Although left ventricular outflow tract ablations pose a risk for coronary artery and heart valve complications, they can be performed successfully and safely with the guidance of three-dimensional mapping.

Keywords

Left ventricular outflow tract arrhythmiaablationthree-dimensional mapping
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lerman, BB, Stein, KM, Markowitz, SM. Mechanisms of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 1997; 8: 571–583.CrossRefGoogle ScholarPubMed
Callans, DJ, Menz, V, Schwartzman, D, et al. Repetitive monomorphic tachycardia from the left ventricular outflow tract: electrocardiographic patterns consistent with a left ventricular site of origin. J Am Coll Cardiol 1997; 29: 1023–1027.CrossRefGoogle ScholarPubMed
Cronin, EM, Bogun, FM, Maury, P, et al. HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation. Heart Rhythm 2020; 17: e2–e154.CrossRefGoogle ScholarPubMed
Pfammater, JP, Paul, T. Idiopathic ventricular tachycardia in infancy and childhood: a multicenter study on clinical profile and outcome: working group on dysrhythmias and electrophysiology of the association for european pediatric cardiology. J Am Coll Cardiol 1999; 33: 2067–2072.CrossRefGoogle Scholar
Nguyen, MB, Ceresnak, SR, Janson, CM, et al. A multicenter review of ablation in the aortic cusps in young people. Pacing Clin Electrophysiol 2017; 40: 798–802.CrossRefGoogle ScholarPubMed
Yamada, T, Kumar, V, Yoshida, N, et al. Eccentric activation patterns in the left ventricular outflow tract during idiopathic ventricular arrhythmias originating from the left ventricular summit: a pitfall for predicting the sites of ventricular arrhythmia origins. Circ Arrhythm Electrophysiol 2019; 12: e007419.CrossRefGoogle Scholar
Borlich, M, Sommer, P. Cardiac mapping systems: rhythmia, topera, enSite precision, and carto. Card Electrophysiol Clin 2019; 11: 4497–458.CrossRefGoogle ScholarPubMed
Hsu, JC, Darden, D, Glover, BM, et al. Performance and acute procedural outcomes of the enSite precisionTM cardiac mapping system for electrophysiology mapping and ablation procedures: results from the enSite precisionTM observational study. J Interv Card Electrophysiol 2022; 65: 141–151.CrossRefGoogle Scholar
Tovia, Oholi, Brodie, MD, Yoav Michowitz, MD, et al. Left ventricular outflow tract arrhythmias: clinical characteristics and site of origin. Imaj 2016; 18: 114–118.Google Scholar
Ouyang, F, Fotuhi, P, Ho, SY, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002; 39: 500–508.CrossRefGoogle ScholarPubMed
Yamada, T, McElderry, HT, Doppalapudi, H, et al. Idiopathic ventricular arrhythmias originating from the aortic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequency catheter ablation. J Am Coll Cardiol 2008; 52: 139–147.CrossRefGoogle ScholarPubMed
Ioannidis, P, Christoforatou, E, Zografos, T, et al. Ventricular ectopy from the non-coronary cusp: pathophysiological and anatomical considerations. Indian Pacing Electrophysiol J 2021; 21: 245–247.CrossRefGoogle ScholarPubMed
Ergul, Y, Ozgur, S, Şahin, GT, et al. Aortic cusp ablation for premature ventricular contractions and ventricular tachycardia in children: a 5-year single-center experience. J Interv Card Electrophysiol 2021; 61: 283–292.CrossRefGoogle ScholarPubMed
Santangeli, P, Lin, D, Marchlinski, FE. Catheter ablation of ventricular arrhythmias arising from the left ventricular summit. Card Electrophysiol Clin 2016; 8: 99–107.CrossRefGoogle ScholarPubMed
Lin, CY, Chung, FP, Lin, YJ, et al. Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: electrocardiographic characteristics and correlative anatomy. Heart Rhythm 2016; 13: 111–121.CrossRefGoogle ScholarPubMed
Yamada, T, McElderry, HT, Doppalapudi, H, et al. Idiopathic ventricular arrhythmias originating from the left ventricular summit anatomic concepts relevant to ablation. Circ Arrhythm Electrophysiol 2010; 3: 616–623.CrossRefGoogle ScholarPubMed
Yoshida, N, Inden, Y, Uchikawa, T, et al. Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outflow tract and aortic sinus cusp ventricular arrhythmias. Heart Rhythm 2011; 8: 349–356.CrossRefGoogle ScholarPubMed
Yoshida, N, Yamada, T, McElderry, HT, et al. A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index. J Cardiovasc Electr 2014; 25: 747–753.CrossRefGoogle ScholarPubMed