Author + information
- Received March 26, 2020
- Revision received May 14, 2020
- Accepted May 17, 2020
- Published online August 12, 2020.
- Michael Ghannam, MD,
- Jackson Liang, DO,
- Ghaith Sharaf-Dabbagh, MD,
- Rakesh Latchamsetty, MD,
- Krit Jongnarangsin, MD,
- Fred Morady, MD and
- Frank Bogun, MD∗ ()
- ↵∗Address for correspondence:
Dr. Frank Bogun, Cardiovascular Center, SPC 5853, Division of Cardiovascular Medicine and Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5853.
Objectives This study sought to establish a mapping and ablation strategy to target intramural ventricular arrhythmias (VAs) by identifying the precise arrhythmia site of origin (SOO).
Background Radiofrequency ablation of intramural VAs is challenging because the arrhythmia origin is difficult to localize.
Methods In 83 consecutive patients with intramural VAs, a stepwise mapping approach was performed: ablation targeted directly the SOO when possible followed by the closest adjacent anatomical structure when necessary. If the SOO could not be identified, the earliest endocardial breakout sites were ablated. Safety and procedural outcomes between patients in whom the SOO could and could not be identified were compared.
Results The SOO was identified in 19 of 83 (23%) patients, and radiofrequency ablation was effective in eliminating VAs in all 19 (100%) patients by ablation at the SOO alone (n = 3), at the SOO and an anatomically adjacent area (n = 7), or at an anatomically adjacent area alone (n = 9). Breakout site mapping and ablation in the remaining 64 patients in whom the SOO was not identified was effective in 43 of 64 patients, which was significantly less than in patients in whom the SOO was identified (67% vs. 100%; p < 0.05).
Conclusions Identification of the SOO was associated with a successful ablation procedure by either targeting the SOO directly or targeting an adjacent anatomical structure. Ablation at the breakout sites of intramural VAs has a lower efficacy than when the SOO can be directly targeted.
The 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 March 26, 2020.
- Revision received May 14, 2020.
- Accepted May 17, 2020.
- 2020 American College of Cardiology Foundation
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