Modern mapping and ablation of idiopathic outflow tract ventricular arrhythmias

Abstract

Outflow tract (OT) premature ventricular complexes (PVCs) are being recognized as a common and often troubling, clinical electrocardiographic finding. The OT areas consist of the Right Ventricular Outflow Tract (RVOT), the Left Ventricular Outflow Tract (LVOT), the Aortomitral Continuity (AMC), the aortic cusps and the Left Ventricular (LV) summit. By definition, all OT PVCs will exhibit an inferior QRS axis, defined as positive net forces in leads II, III and aVF. Activation mapping using the contemporary 3D mapping systems followed by pace mapping is the cornerstone strategy of every ablation procedure in these patients. In this mini review we discuss in brief all the modern mapping and ablation modalities for successful elimination of OT PVCs, along with the potential advantages and disadvantages of each ablation technique.

Radiofrequency ablation of premature ventricular contractions guided by robotic magnetic navigation combined with pattern matching filter

“…Although the mapping was time‐consuming and slightly less accurate than that in the PMF group, the increased energy delivery time made up for the lack of accuracy of mapping. According to previous studies, success rates with PVCs ablation can vary according to PVCs sites of origin, electrophysiological characteristics, ablation techniques, radiofrequency energy delivery and experience of operator 7,13 . So we suggest that PMF can only help us obtain mapping points quickly, shorten the procedure time.…”

“…A considerable percentage of PVCs originate from the outflow tract (OT) of either the RV or the LV, and this study yielded similar results. 13 The proportion of PVCs originating from the RVOT alone accounted for more than half at 57.6% (68/118).…”

TREK-1 in the heart: Potential physiological and pathophysiological roles

“…While the physiological role of TREK-1 has not been proven formally, some cardiac diseases have been shown to be associated with changes in TREK-1 expression and the implication of TREK-1 can be inferred based on its electrophysiological properties or even proved by restoration of the initial expression ( Zhao et al, 2011 ; Benoist et al, 2014 ; Lugenbiel et al, 2017 ; Kamatham et al, 2019 ; Dragasis et al, 2022 ).…”

“…The RVOT is under a high physical strain and is known to express TREK-1. A significant proportion of ventricular extrasystoles originate from the outflow tracts, left or right ( Dragasis et al, 2022 ).…”

Acupuncture for premature ventricular complexes without ischemic or structural heart diseases: A systematic review and meta-analysis of clinical and pre-clinical evidence

“…Standard treatment for PVCs mainly consists of anti-arrhythmic medications such as beta-blockers, non-dihydropyridine calcium channel blockers ( 1 ); for severe PVCs cases that are either symptomatic or likely responsible for systolic dysfunction, or patients who are intolerant or do not respond well to medications, catheter ablation should be considered ( 1 , 3 , 5 , 8 , 9 ). These mainstream treatments for PVCs are facing the following challenges: (1) anti-arrhythmic medications do not provide symptom relief to all patients undertaking anti-arrhythmic medications ( 10 ); (2) catheter ablation is an invasive procedure which may eradicate PVCs, but recurrence or worsening of PVCs after the procedure are often observed in clinical practice ( 11 ); (3) catheter ablation is generally considered and recommended in PVCs originated from a right ventricular outflow tract.…”