Pulmonary sinus cusps mapping and ablation: a new concept and approach for idiopathic right ventricular outflow tract arrhythmias

Abstract

Objective The aim of our study was to assess if mapping and ablation in palmonary sinns cusps (PSC) might be an appropriate first choice for treatment in unselected patients with idiopathic right ventricular outflow tract (RVOT) ventricular arrhythmias (VA) . Methods Ninety consecutive patients with VAs of RVOT-type origin were prospectively enrolled in our institution from August 2015 to September 2016. Pulmonary valve (PV) and PSC were precisely localized by pulmonary arteriography. Activation and pacemapping were performed in PSC and RVOT region below the PV, and ablation was preferentially performed in PSC. Results In 81 (90%) patients, earliest activation of VAs was found in PSC, and ablation resulted in elimination of VAs without any additional ablation in RVOT region underneath the PV. The best pacemapping was obtained at successful ablation sites in PSC in 96.3% patients. In the remaining 9 patients, final successful ablations were achieved in the aortic coronary cusps (5 cases) , and at the lowest and most posterior part of the RVOT (in 4 cases) . During mean (15.2±9.5) months follow-up, single procedural success rate was 96.7%. Conclusion In the present single center, prospective study, a strategy based on PSC mapping and ablation eliminated 90% (81/90) of unselected idiopathic RVOT-type VA with favorable midterm effectiveness. Key words: Catheter ablation; Ventricular arrhythmias; Right ventricular outflow tract