Abstract 11129: Long-Term Success Rate of Intramural PVC Ablation

Abstract

Introduction: Intramural PVCs are identified by equal but not remarkably early activation on at least two separate sites. The site of origin of these foci is typically determined by a deductive approach using extensive mapping in the surrounding areas. Ablation of the intramural VT is particularly challenging, since conventional ablation strategies often fail to obtain transmural lesion formation. We report the long-term success rate of ablation of the intramural PVCs at our center. Methods: Consecutive patients undergoing VT ablation at our center were screened and 73 patients with intramural PVCs identified by activation mapping and pace mapping were included in the analysis. Pace-mapping was performed at a pacing cycle length equal to the coupling interval of the spontaneous PVCs. If these PVCs could not be eliminated by conventional ablation, bipolar ablation or ablation from multiple sides or ablation using half-normal saline (HNS) was performed. Standardized RF power settings (up to 40W) were used during the procedure. Ablation was performed using 4-mm irrigated tip catheter guided by 3-D mapping system and intra-cardiac echocardiography. Patients were followed with remote monitoring as well as ICD interrogations and office visits every 3 months for 3 years. Results: A total of 73 patients were included in the analysis (mean age 56.2±8.6 years, 69.8% male, LVEF 54±12%). The intramural focus was effectively ablated by bipolar ablation or ablation from multiple sides in 51 (69.8%) and with the use of HNS in the remaining 22 patients. Median RF time was 11.14±8.7 minutes. Acute success (non-inducibility of the VT) was achieved in 71 (97.2%) patients. At 3 years follow-up, 66 (90.4%) remained arrhythmia-free. Conclusion: Intramural PVCs could be successfully ablated using bipolar or multiple-side ablations or utilizing half-normal saline with high long-term success rate.