Arrhythmias & electrophysiology
Catheter Ablation of Right Ventricular Endocavitary Arrhythmias
Authors' conclusion
RV endocavitary arrhythmias typically occur in structurally normal hearts as focal PVCs. PVCs-triggering VF have shorter CIs and preferentially arise from the lateral MB. Ablation is effective in management.
Study context
- Population
- Patients undergoing catheter ablation of right ventricular (RV) endocavitary arrhythmias(1.4%) of 3,873 patients undergoing ventricular arrhythmia ablation between 2013 and 2025
- Participants
- 53 patients
- Outcome
- Substrate
Main finding
As reported in the abstract
Structurally normal hearts
Forty-three (81%)
Nonischemic cardiomyopathy
10
19%
Of whom premature ventricular contraction (PVC)-mediated cardiomyopathy
7
Of whom idiopathic nonischemic cardiomyopathy
3
Further findings
Ablation indications
- PVCs
- n = 25
- PVC-triggered ventricular fibrillation (VF)
- n = 20
- Ventricular tachycardia
- n = 8
Predictor of PVC-mediated cardiomyopathy
- PVC QRS duration independently predicted developing PVC-mediated cardiomyopathy
- P = 0.02
Coupling intervals of PVCs-triggering VF
- PVCs-triggering VF vs other coupling intervals (CIs) (ms)
- 320 [295-358] vs 440 [400-470] ms; P < 0.05
- More frequently originated at the lateral moderator band (MB)
- P = 0.03
- Lateral MB PVCs shorter CIs than medial MB PVCs
- P = 0.01
Ablation targets
- MB
- n = 47
- Anterior papillary muscle (PM)
- n = 3
- Inferior PM
- n = 2
- Conus PM
- n = 1
Postablation ECG changes
- Sinus rhythm QRS duration
- 98 [84-102] to 102 [90-114] ms; P < 0.01
- V1 intrinsicoid deflection
- 22 [18-27] to 26 [20-95] ms; P < 0.01
- New right bundle branch block
- 15% of patients
- Did not translate into RV dysfunction or worsening tricuspid valve function
Energy source
- Radiofrequency energy
- 49
- Adjunctive cryoablation
- 6
- Cryoablation alone
- 4
Clinical success · 3.6 (1.6-5.7) years follow-up
- Clinical success with reduced antiarrhythmic drug use
- 89%
Original publication
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