Author + information
- Received June 20, 2019
- Revision received September 10, 2019
- Accepted October 3, 2019
- Published online November 27, 2019.
- Tatsuya Hayashi, MDa,b,∗,
- Jackson J. Liang, DOa,c,∗,
- Yasuhiro Shirai, MDa,b,
- Ling Kuo, MDa,
- Daniele Muser, MDa,
- Maciej Kubala, MDa,
- Ramanan Kumareswaran, MDa,
- Jeffrey S. Arkles, MDa,
- Fermin C. Garcia, MDa,
- Gregory E. Supple, MDa,
- Robert D. Schaller, DOa,
- David S. Frankel, MDa,
- Michael P. Riley, MD, PhDa,
- David Lin, MDa,
- Pasquale Santangeli, MD, PhDa,
- Erica S. Zado, PA-Ca,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa and
- Sanjay Dixit, MDa,∗ ()
- aCardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- cElectrophysiology Section, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Sanjay Dixit, Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion–Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to examine clinical characteristics of procedural and long-term outcomes in patients undergoing catheter ablation (CA) of outflow tract ventricular arrhythmias (OT-VAs) over 16 years.
Background CA is an effective treatment strategy for OT-VAs.
Methods Patients undergoing CA for OT-VAs from 1999 to 2015 were divided into 3 periods: 1999 to 2004 (early), 2005 to 2010 (middle), and 2011 to 2015 (recent). Successful ablation site (right ventricular OT, aortic cusps/left ventricular OT, or coronary venous system/epicardium), VA morphology (right bundle branch block or left bundle branch block), and acute and clinical success rates were assessed.
Results Six hundred eighty-two patients (336 female) were included (early: n = 97; middle: n = 204; recent: n = 381). Over time there was increase in use of irrigated ablation catheters and electroanatomic mapping, and more VAs were ablated from the aortic cusp/left ventricular OT or coronary venous system/epicardium (14% vs. 45% vs. 56%; p < 0.0001). Acute procedural success was achieved in 585 patients (86%) and was similar between groups (82% vs. 84% vs. 88%; p = 0.27). Clinical success was also similar between groups (86% vs. 87% vs. 88%; p = 0.94), but more patients in earlier periods required repeat ablation (18% vs. 17% vs. 9%; p = 0.02). Overall complication rate was 2% (similar between groups).
Conclusions Over a 16-year period there was an increase in patients undergoing CA for OT-VTs, with more ablations performed at non–right ventricular outflow tract locations using electroanatomic mapping and irrigated-tip catheters. Over time, single procedure success has improved and complications have remained limited.
↵∗ Drs. Hayashi and Liang contributed equally to this work and are joint first authors.
This study was supported by the Pennsylvania Steel Company and the Mark S. Marchlinski EP Research Funds in Cardiac Electrophysiology at the University of Pennsylvania. Dr. Kumareswaran has been an education consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 20, 2019.
- Revision received September 10, 2019.
- Accepted October 3, 2019.
- 2019 American College of Cardiology Foundation
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