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Non-contact multi-electrode balloon catheter mapping-guided ablation of ventricular arrhythmias originating from the outflow tract
Session:
Painel 4 - Arritmologia 7
Speaker:
Inês Grácio Almeida
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Inês Grácio De Almeida; Ana Lousinha; Pedro Silva Cunha; Bruno Tereno Valente; Guilherme Portugal; Madalena Coutinho Cruz; Antonio; Ana Sofia Delgado; Mário Martins Oliveira; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> The outflow tract (OT) regions of the ventricles are a common location of origin of idiopathic ventricular arrhythmias (VA). Non-contact mapping (NCM) with a multi-electrode balloon catheter <em>Ensite-Array</em> enables three-dimensional reconstruction of the geometry of the cardiac chamber and an accurate mapping of the propagation map, based on a single-beat analysis, facilitating the ablation and contributing to the success of the procedure. </p> <p><strong>Objective: </strong>Evaluation of feasibility and long-term outcomes following NCM-guided VA ablation. </p> <p><strong>Methods: </strong>Single centre retrospective analysis of patients´ admitted for symptomatic OT VA ablation. Demographic and clinical characteristics of patients, procedure data and outcomes were evaluated. </p> <p><strong>Results: </strong>58 patients (79.3% female gender, mean age 43.9±17.6 years). Structural heart disease was excluded by echocardiography and/or cardiac magnetic resonance in 89.7% of the patients. An underlying cardiac disease was present in 7 cases: surgically corrected atrial septal defect (n=1), repaired Fallot tetralogy (n=1), ischemic cardiomyopathy (n=1), idiopathic dilated cardiomyopathy (n=1), mitral valve prolapse (n=1) and right ventricle dysfunction of unknown etiology (n=2). Most cases (75%) presented with palpitations, 13.5% with fatigue and 11.5% with presyncope/syncope. 24h-Holter recording documented sustained VA episodes in 12.1% of the patients, non-sustained VA in 31.0%, and >10000 ventricular ectopic complex (VEC) in 56.9%, with an ECG suggesting OT origin. NCM-guided ablation included 3D-reconstruction of ventricular geometry, followed by acquisition of maps during sinus rhythm and VEC beats, to identify the early activation points. The origin of the arrhythmia was in the right ventricle OT in 84.5% and in the left OT in 15.5%. A mean of 13±8 RF applications was delivered to the target sites: posteroseptal - 31.5%, posterolateral - 16.7%, posterior - 13%, anterolateral - 11.1%, and other OT locations - 17.7%. The acute success rate was: total elimination of VEC - 87.9%; significant reduction of VEC -3.4%. In 8.6% the ablation was non-successful. In 4 cases, the procedure was complicated due to pericardial effusion (n=1), cardiac tamponade (n=2) and a pseudo-aneurysm of the femoral artery (n=1). During a mean follow-up of 28 months, most patients (87.9%) remained asymptomatic without medication after the first ablation, 12.1% of the patients were submitted to re-ablation due to symptomatic VEC recurrence, and 2 cases underwent a third successful intervention.</p> <p><strong>Conclusion: </strong>NCM-guided multi-electrode balloon catheter VA ablation is a highly effective and safe procedure, with a low rate of long-term recurrence.</p>
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