Catheter ablation of premature ventricle complex from multiples site of origin guided by an ultra-high density mapping system in a single-center

Abstract

Abstract Background Frequent premature ventricle complex (PVC) could induce cardiomyopathy in some patient. PVC ablation by radiofrequency (RF) is a well-stablished procedure in high density PVC patients and results are consistent and robust in literature, with somewhat differing success rates reported. Catheter ablation of radiofrequency guided by ultra-high density mapping systems (UHDMS), enable a much more accurate reconstruction of the site of origin (SOO). Furthermore, we obtained this anatomic recreation with the analysis of a few number of beats. The UHDMS have demonstrated to be feasible and safe in a wide range / large spectrum of arrhythmic substrates, however, there is lack of evidence of its usefulness in the ablation of PVC. Purpose To determine the safety and utility, both in the acute phase and in the short-medium term, of employing a UHDMS in PVC catheter ablation in a retrospective cohort of patients treated at a single centre. Methods Catheter ablation procedures guided by an UHDMS carried out from July 2015 to January 2021 in a single-center of Spain were retrospectively included. The primary outcomes analyzed were: acute success rate, short-medium success rate (6-month efficacy after ablation), and complication rate related to the procedure. Results One hundred and two procedures, corresponding to 92 patients (mean age 59 ± 14 years, 63% male, 74% without cardiomyopathy, mean LVEF of 60%), were analyzed. The acute success rate was 93%. According the SOO, the lowest acute success rate was PVC from epicardial level (LV Summit) (75%). At 6-month follow-up after the first procedure, the short-medium success rate was up to 84% (no recurrence of the PVC ablated). There were three acute complications related to the procedure (complication rate 2,94%). In 19% (21 out 102) of the procedures, at least two arrhythmic substrates were successfully ablated in a single intervention. Conclusion Catheter ablation guided by an UHDMS showed an excellent safety profile in PVC ablation procedures. Beyond this minor complication rate, this type of technique has improved acute and short-term success rates. This allows us to assert that this type of technique grants a very high success rate and improves previously results. Last but not least, this new approach was useful and accurate in complex patients, providing good results in ablation procedures of two or more arrhythmic substrates without altering the safety profile.