Ablation within the aortic sinus of Valsalva for the treatment of ventricular arrhythmias using a standard electrophysiology and ablation system

Abstract

Background: Ablation within the aortic sinus of Valsalva for ventricular tachycardia (VT)/ premature ventricular complexes (PVCs) has been reported in only small patient cohorts. Limited data exists concerning the outcome and safety of aortic ablation. Aims: The aim was to study the preliminary result and safety of catheter ablation for VT/PVCs originating from the aortic cusps. Methods: The study consisted of 49 consecutive patients with symptomatic VT/PVCs who underwent radiofrequency catheter ablation within aortic sinus cusps from January 2010 to April 2012. All the procedures were performed with conventional EP and ablation system. Aortic root angiography was used to define coronary cusp and catheter position. The ablation target sites were defined by pace mapping and early activation mapping techniques. Ablation parameters including tissue temperature and tissue impedance were also measured. Ablation success and recurrence was defined by ECG and clinical follow up and 24-hour Holter monitoring after 3 months. All the procedure-related complications were documented. Results: Of the 49 patients (24 men and 25 women, mean age 51.1 ± 13.7 years), the site of origin was the left coronary cusp (LCC) in 36 (73.4%), the right coronary cusp (RCC) in 5 (10.2%), the noncoronary cusp (NCC) in 2 (4.1%), and at the junction between the LCC and RCC (L-RCC) in 6 (12.3%) cases. The initial success rate was 93.9% (46/49). After a mean follow-up period of 12.5 ± 6.6 months, 41/49 (83.7%) were free of VT/PVCs without antiarrhythmic drugs. No severe complications (MI, strokes, aortic valve perforation…) have been documented. Conclusion: Ablation within the aortic sinus of Valsalva is safe and effective for the treatment of ventricular arrhythmias.