Reversed U-curve mapping and ablation of the left pulmonic cusp for treatment of the left ventricular summit arrhythmias

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation (CA) of the left ventricular summit (LVS) arrhythmias can be challenging. Close proximity of the left pulmonic cusp (LPC) offers a unique opportunity for targeting the LVS region. Whether LPC can serve as a vantage point for mapping and CA of LVS premature ventricular contractions (PVC) and ventricular tachycardia (VT) has not yet been systematically evaluated. Methods This is a retrospective analysis of consecutive patients who underwent CA of LVS PVC/VT and concomitant mapping and/or ablation within the LPC using reversed U-curve technique. PVC/VT activation precocity was determined and CA (unipolar, sequential unipolar and/or bipolar ablation) was performed involving LPC when necessary. Results A total number of 18 patients (age 59±15 years, 10 females) were included in this study. LPC mapping using reversed U-curve was successful in 17 (94%) patients. An earliest PVC/VT activation was recorded in LPC in 7 (39%). No early activation in the LPC was found in 5 (28%) patients. Selective LPC ablation (24W, 206s) led to acute suppression with late VT recurrence in one patient, whereas LPC served as an additional ablation target for sequential CA (37±4W, 416±252s) in 11 (61%) patients. 6 (33%) patients required combined sequential unipolar and bipolar CA (37±8W, 690±248s) between LPC and adjacent LVOT and this approach led to PVC/VT elimination in 5 patients. There were no procedure-related complications. During follow up 4 (22%) patients required redo ablation. Ultimately clinical success was achieved in 14 (78%) patients. Conclusions LPC mapping of LVS PVC/VT using reversed U-curve is safe and can be helpful for determination of LVS arrhythmia site of origin. While LPC ablation alone is rarely successful in eliminating LVS arrhythmias, it can serve as an anatomical vantage point for additional ablation of LVS PVC/VT as a part of sequential unipolar or bipolar CA.