Novel electrophysiological criteria for septal ventricular outflow tract tachycardias requiring a sequential bilateral ablation

作者：Lin Chin-Yu; Chung Fa-Po; Lin Yenn-Jiang; Chang Shih-Lin; Lo Li-Wei; Hu Yu-Feng; Liao Jo-Nan; Tuan Ta-Chuan; Chao Tze-Fan; Chang Yao-Ting; Chen Yun-Yu; Te Abigail Louise D.; Yamada Shinya; Kuo Ling; Vicera Jennifer Jeanne B.; Chang Ting-Yung; Hoang Quang Minh; Salim Simon; Huang Ting-Chung; Chen Shih-Ann^*

来源：Journal of Cardiovascular Electrophysiology, 2018, 29(2): 298-307.

DOI：10.1111/jce.13376

• absolute earliest activation time discrepancy
• catheter ablation
• distance between bilateral earliest activation sites of outflow tract
• outflow tract ventricular arrhythmia
• recurrence

Background: Septal ventricular outflow tract ventricular arrhythmias (OT-VAs) are defined as septal origin VAs from the right ventricular or left ventricular OT. Patients with septal OT-VAs may require a sequential bilateral OT ablation. This study aimed to evaluate the electrophysiological characteristics and ablation outcome in patients with septal OT-VAs.
Methods: We retrospectively analyzed the electrocardiography and electrophysiological parameters in 96 patients (mean age 49 +/- 15 years, 49 male) undergoing bilateral activation mapping before catheter ablation of idiopathic septal OT-VAs. The patients were categorized into three groups based on the successful ablation sites, including the right ventricular outflow tract (RVOT), RVOT/left ventricular outflow tract (LVOT), and LVOT.
Results: Mapping in the three groups demonstrated a gradually decreasing and increasing trend in the earliest activation time obtained from the RVOT and LVOT, respectively. The absolute earliest activation time discrepancy (AEAD) of <= 18 milliseconds could predict the requirement for a sequential bilateral ablation with a sensitivity and specificity of 100.0% and 93.7%, respectively. The small AEAD (<= 21 milliseconds) was associated with a higher recurrence rate in patients receiving a successful unilateral ablation, while patients with a longer distance between the bilateral OT earliest activation sites (DEA > 26 mm) increased future recurrences after an initially successful sequential bilateral ablation.
Conclusions: The application of bilateral OT-VA activation mapping and the measurement of the AEAD and DEA provided not only pivotal information for the ablation strategy, but also prognostic implications for recurrences in patients with septal OT-VAs.

• 出版日期2018-2