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

Abstract

AIMS

Ventricular arrhythmias (VAs) originating from the para-Hisian region represent a challenging location. The long-term success rate of catheter ablation above the septal leaflet of the tricuspid valve is not ideal. This study aimed to investigate the safety and efficacy of catheter ablation for para-Hisian VAs via a direct approach under the septal valve with reversed C-curve technique.

METHODS AND RESULTS

Twenty-five consecutive patients with para-Hisian VAs were included. Systematic mapping was performed in the right ventricle septum, including both the regions above and under the septal valve. Radiofrequency (RF) ablation was preferentially performed under the valve with reversed C-curve technique in all patients. If the ablation failed under the valve, it was then performed above the valve and even in aortic sinus cusps. The earliest ventricular activation preceding surface QRS (V-QRS) under the valve was significantly larger than that above the valve (34.8 ± 5.3 vs 27.8 ± 5.7 ms, P < .01). RF ablation under the valve with reversed C-curve technique achieved acute success in 22 of 25 (88%) patients. Junctional rhythm developed during ablation in 3 of 25 (12%) patients and no atrioventricular block occurred. In the remaining three patients, RF application above the valve failed to eliminate the VAs and one of them achieved successful ablation in the right coronary cusp. During a mean follow-up of 17.8 ± 9.4 months, no patients presented with VAs recurrence and no postprocedure complications occurred.

CONCLUSIONS

Catheter ablation under the valve with reversed C-curve technique shows to be effective and safe for para-Hisian VAs.

Authors+Show Affiliations

Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Clinical Research Unit, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31512322

Citation

Sun, Jian, et al. "Catheter Ablation of Ventricular Arrhythmias Originating From the para-Hisian Region With Reversed C-curve Technique." Journal of Cardiovascular Electrophysiology, 2019.
Sun J, Zhang PP, Wang QS, et al. Catheter ablation of ventricular arrhythmias originating from the para-Hisian region with reversed C-curve technique. J Cardiovasc Electrophysiol. 2019.
Sun, J., Zhang, P. P., Wang, Q. S., Xu, Q. F., Wang, Z. Q., Yu, Y., ... Li, Y. G. (2019). Catheter ablation of ventricular arrhythmias originating from the para-Hisian region with reversed C-curve technique. Journal of Cardiovascular Electrophysiology, doi:10.1111/jce.14170.
Sun J, et al. Catheter Ablation of Ventricular Arrhythmias Originating From the para-Hisian Region With Reversed C-curve Technique. J Cardiovasc Electrophysiol. 2019 Sep 11; PubMed PMID: 31512322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Catheter ablation of ventricular arrhythmias originating from the para-Hisian region with reversed C-curve technique. AU - Sun,Jian, AU - Zhang,Peng-Pai, AU - Wang,Qun-Shan, AU - Xu,Quan-Fu, AU - Wang,Zhi-Quan, AU - Yu,Ying, AU - Zhou,Qian, AU - Han,Ya-Qin, AU - Li,Wei, AU - Li,Yi-Gang, Y1 - 2019/09/11/ PY - 2019/05/29/received PY - 2019/09/01/revised PY - 2019/09/05/accepted PY - 2019/9/13/pubmed PY - 2019/9/13/medline PY - 2019/9/13/entrez KW - catheter ablation KW - para-Hisian KW - reversed C-curve technique KW - tricuspid annulus KW - ventricular arrhythmias JF - Journal of cardiovascular electrophysiology JO - J. Cardiovasc. Electrophysiol. N2 - AIMS: Ventricular arrhythmias (VAs) originating from the para-Hisian region represent a challenging location. The long-term success rate of catheter ablation above the septal leaflet of the tricuspid valve is not ideal. This study aimed to investigate the safety and efficacy of catheter ablation for para-Hisian VAs via a direct approach under the septal valve with reversed C-curve technique. METHODS AND RESULTS: Twenty-five consecutive patients with para-Hisian VAs were included. Systematic mapping was performed in the right ventricle septum, including both the regions above and under the septal valve. Radiofrequency (RF) ablation was preferentially performed under the valve with reversed C-curve technique in all patients. If the ablation failed under the valve, it was then performed above the valve and even in aortic sinus cusps. The earliest ventricular activation preceding surface QRS (V-QRS) under the valve was significantly larger than that above the valve (34.8 ± 5.3 vs 27.8 ± 5.7 ms, P < .01). RF ablation under the valve with reversed C-curve technique achieved acute success in 22 of 25 (88%) patients. Junctional rhythm developed during ablation in 3 of 25 (12%) patients and no atrioventricular block occurred. In the remaining three patients, RF application above the valve failed to eliminate the VAs and one of them achieved successful ablation in the right coronary cusp. During a mean follow-up of 17.8 ± 9.4 months, no patients presented with VAs recurrence and no postprocedure complications occurred. CONCLUSIONS: Catheter ablation under the valve with reversed C-curve technique shows to be effective and safe for para-Hisian VAs. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/31512322/Catheter_ablation_of_ventricular_arrhythmias_originating_from_para-Hisian_region_with_reversed_C-curve_technique L2 - https://doi.org/10.1111/jce.14170 DB - PRIME DP - Unbound Medicine ER -