Arrhythmias & electrophysiology
Stepwise Anatomical Approach to Ablation of Intramural Outflow Tract Ventricular Arrhythmias Guided by Septal Coronary Venous Mapping
Authors' conclusion
Most intramural OT PVCs can be successfully eliminated with endocardial ablation adjacent to the earliest intramural activation site. A high success rate is achieved when following a stepwise approach, with bailout ablation strategies required in a minority of cases.
Study context
- Population
- Patients with intramural outflow tract premature ventricular complexes (PVCs) (earliest activation in a septal coronary vein)
- Participants
- 60 patients
- Outcome
- Efficacy of stepwise ablation approach (PVC suppression)
Methodological detailsconsecutive patients, stepwise ablation approach
- Consecutive patients
- Stepwise ablation approach
Main finding
As reported in the abstract
- Acute PVC suppression at end of procedure
- all cases
- Endocardial ablation (LV outflow tract (OT), RV OT or both) successful
- 87% (n=52)
- PVC eliminated with ethanol infusion
- n=7
- PVC eliminated with bipolar ablation
- n=1
Observational data: associations, not effects.
Further findings
PVC burden during follow-up · 17±24 months
- PVC burden before
- 28±12%
- PVC burden after
- 2.3±4.7%
- Long-term success (≥80% burden reduction)
- 88%
Safety
Complications
- Pericardial effusion related to venous mapping
- 1
Original publication
Stepwise Anatomical Approach to Ablation of Intramural Outflow Tract Ventricular Arrhythmias Guided by Septal Coronary Venous Mapping. Circulation. Published 26 April 2025. doi:10.
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