A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation.

Ling-Cong Kong,Jun Pu,Tian Shuang,Wen-Long Jiang,Zheng Li,Zhi-Guo Zou,Xin-Hua Wang

doi:10.3389/fcvm.2022.844320

Abstract

BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.

Highlights

Catheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB)
The B-septal leaflet of the tricuspid valve (SLTV) approach might be superior to the above SLTV (A-SLTV) approach in terms of effectiveness and safety, and was recommended for PHVAs ablation in recent studies [10, 11]; catheter ablation might fail even by the beneath the SLTV (B-SLTV) approach in a considerable proportion of patients [11]
Among the electrocardiographic and procedural parameters, target-His bundle (HB) distance was the only factor that could predict successful B-SLTV ablation for right PHVA

Summary

Introduction

Catheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). The B-SLTV approach might be superior to the A-SLTV approach in terms of effectiveness and safety, and was recommended for PHVAs ablation in recent studies [10, 11]; catheter ablation might fail even by the B-SLTV approach in a considerable proportion of patients [11]. In this scenario sequential mapping at the A-SLTV region, the neighboring left parahisian area or the aortic root might help to improve the outcomes [12].

Results

Discussion

Conclusion