Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Sun, Jian; Zhang, Peng‐Pai; Wang, Qunshan; Qiao, Xu; Wang, Zhiquan; Yu, Ying; Zhou, Qian; Han, Yuxiao; Li, Wei; Li, Yi‐Gang

doi:10.1111/jce.14170

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…In recently years, the novel B-SLTV ablation (also known as “catheter inversion” technique, “reversed C-curve technique,” etc.) began to be applied for PHVA ablation, with a high success rate of 88% reported in a latest cohort study of 28 cases ( 11 ). The advantages of the B-SLTV approach over the conventional A-SLTV approach lay in two aspects: one was better catheter tip-tissue contact and more efficient energy delivery; the other was less risk of AVB, which was demonstrated in an animal study.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, to abolish intramural foci, RF ablation in the contralateral region might be necessary, rather than repeated B-SLTV ablation. Moreover, to ablate the ectopic focus extremely close to the AVN-HB, the B-SLTV approach was not always effective or safe and the A-SLTV approach/anatomical ablation at the neighboring structures might be effective ( 11 , 12 ). The adjunctive A-SLTV approach succeeded in 6 of 12 cases who experienced B-SLTV ablation failure in our study.…”

Section: Discussionmentioning

confidence: 99%

“…A novel technical improvement is to curve the catheter tip reversely and place it beneath the SLTV (B-SLTV) to acquire good proximity to the basal interventricular septum ( 9 , 10 ). The B-SLTV approach might be superior to the A-SLTV approach in terms of effectiveness and safety, and was recommended for PHVAs ablation in recent studies ( 10 , 11 ); Nevertheless, catheter ablation might fail even by the B-SLTV approach in a considerable proportion of patients ( 11 ). In this scenario sequential mapping at the A-SLTV region, the neighboring left parahisian area or the aortic root might help to improve the outcomes ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

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A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

Kong

Tian

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

Kong

Tian

et al. 2022

Front. Cardiovasc. Med.

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“…One patients developed only transient AVB, and another developed high-grade AVB requiring a pacemaker [ 4 ]. Sun J et al reported catheter ablation of ventricular arrhythmias originating from the para-Hisian region with reversed C curve technique, during a mean follow‐up of 17.8 ± 9.4 months, no patients presented with VAs recurrence and no post procedure complications especially AVB occurred [ 15 ]. Miyamoto et al reported that cryoablation can achieve acute success rate of 70% (7/10) for para-Hisian PVCs by antegrade technique.…”

Section: Discussionmentioning

confidence: 99%

“…While the mechanism of AVN-PVCs cannot be determined from a clinical study, an appreciation of the particular anatomy and the lack of overlying connective muscular tissue of the distal compact AVN and proximal His bundle potentially provides some insights [ 15 , 17 , 18 ]. Different EP characteristics between the AVN-His conduction system and the neighbouring ventricular myocardium which practically may potentially provide the anisotropic conduction necessary for the initiation of re-entry, abnormal automaticity or triggered activity, was speculated as to the role of these tissues in ventricular arrhythmogenesis.…”

Section: Discussionmentioning

confidence: 99%

Premature ventricular contractions with acute successful radiofrequency catheter ablation near the atrioventricular node using reversed C curve technique

Jiang

Wang

2022

BMC Cardiovasc Disord

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Background We sought to clarify the electrophysiological (EP) characteristics of premature ventricular contractions (PVCs) with acute successful radiofrequency catheter ablation (RFCA) near the atrioventricular node (AVN). Methods and results Eighteen patients with acute successful RFCA near the AVN were included in this study. Systematic mapping was performed with two mapping methods: antegrade mapping technique (group A) and reversed C curve mapping technique (group R). RFCA was preferentially performed underneath the tricuspid valve (TV) with reversed C curve technique in all patients. The a amplitude/v amplitude ratio during sinus rhythm in group A was significantly larger than in group B (0.19 ± 0.10 vs 0.06 ± 0.02, p < 0.01). The earliest bipolar activation preceded the QRS onset in group A was significantly smaller than in group R (19.6 ± 4.9 vs 24.4 ± 6.6 ms (ms), p < 0.01). Pace mapping in group A and group R demonstrated perfect QRS morphology (12/12) match only in 5.6% (one patient) and 16.7% (3 patients) of patients, respectively. The mean duration of successful RFCA was 8.2 ± 2.4 s in 13 patients (72.2%). Early (within 3 days) and late (one-year) recurrence rates were 5.6% (one patient) and 16.7% (3 patients), respectively. No atrioventricular block occurred during RFCA or the one-year follow up. Conclusions PVCs near the AVN are a subgroup of idiopathic PVCs with distinctive EP features. RFCA using reversed C curve technique is effective and safe for the acute elimination of these challenging AVN-PVCs.

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The comparison between the novel technique and conventional method in the catheter ablation of premature ventricular contractions originating from the free wall of tricuspid annulus

Chen,

Wang,

Zhu

et al. 2023

Clinical Cardiology

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BackgroundThis study aimed to assess the safety and effectiveness of a novel technique for catheter ablation in patients with premature ventricular contraction (PVC) from the free wall of tricuspid annulus (TV).HypothesisWe hypothesized that the novel technique is more efficacious than the traditional approach.MethodsWe retrospectively investigated 59 consecutive patients with PVC originating from the free wall of TV between January 2013 and November 2021. The patients were divided into two groups: the reversed S‐curve technique group (RST, n = 26) and the reversed C‐curve technique group (RCT, n = 33). The RST under the support of a steerable sheath was used in RST group, while the RCT under the support of a nonsteerable sheath was used in the RCT group. Systematic mapping and radiofrequency ablation were preferentially performed under the valve in all patients.ResultsCompared to the RCT group, total procedural time and fluoroscopic exposure time were significantly shorter in RST group. Two patients experienced cardiac tamponade in the RCT group, while no complications were observed in RST group (p = .498). The success rate was significantly higher in RST group compared to RCT group (81.9% vs. 100%, p = .029). Three patients in RCT group failed to ablate during the operation but were successfully ablated using the novel method. During regular follow‐up, no patients in the RST group had a recurrence, while three patients in the RCT group did (p = .274).ConclusionsIt suggests that the reserved S‐curve technique, supported by a steerable sheath, is a feasible and effective method for ablating PVC originating from the free wall of TV.

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Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Cited by 11 publications

References 23 publications

A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

Premature ventricular contractions with acute successful radiofrequency catheter ablation near the atrioventricular node using reversed C curve technique

The comparison between the novel technique and conventional method in the catheter ablation of premature ventricular contractions originating from the free wall of tricuspid annulus

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