Catheter ablation for fascicular ventricular tachycardia: A systematic review

Antonio Creta; Anthony W Chow; Simon Sporton; Malcolm Finlay; Nikolaos Papageorgiou; Shohreh Honarbakhsh; Gurpreet Dhillon; Adam Graham; Kiran H K Patel; Mehul Dhinoja; Mark J Earley; Ross J Hunter; Martin Lowe; Edward Rowland; Oliver R Segal; Vito Calabrese; Danilo Ricciardi; Pier D Lambiase; Richard J Schilling; Rui Providência

doi:10.1016/j.ijcard.2018.10.080

Catheter ablation for fascicular ventricular tachycardia: A systematic review

Int J Cardiol. 2019 Feb 1:276:136-148. doi: 10.1016/j.ijcard.2018.10.080. Epub 2018 Oct 25.

Authors

Antonio Creta¹, Anthony W Chow², Simon Sporton², Malcolm Finlay², Nikolaos Papageorgiou², Shohreh Honarbakhsh², Gurpreet Dhillon², Adam Graham², Kiran H K Patel³, Mehul Dhinoja², Mark J Earley², Ross J Hunter², Martin Lowe², Edward Rowland², Oliver R Segal², Vito Calabrese⁴, Danilo Ricciardi⁴, Pier D Lambiase², Richard J Schilling², Rui Providência²

Affiliations

¹ Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Campus Bio-Medico University of Rome, Rome, Italy. Electronic address: creta.antonio@gmail.com.
² Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
³ Northwick Park Hospital, London, United Kingdom.
⁴ Campus Bio-Medico University of Rome, Rome, Italy.

PMID: 30463682
DOI: 10.1016/j.ijcard.2018.10.080

Abstract

Introduction: Catheter ablation has been evaluated as treatment for fascicular ventricular tachycardia (FVT) in several single-centre cohort studies, with variable results regarding efficacy and outcomes.

Methods: A systematic search was performed on PubMed, EMBASE and Cochrane database (from inception to November 2017) that included studies on FVT catheter ablation.

Results: Thirty-eight observational non-controlled case series comprising 953 patients with FVT undergoing catheter ablation were identified. Three studies were prospective and only 5 were multi-centre. Eight-hundred and eighty-four patients (94.2%) had left posterior FVT, 25 (3.4%) left anterior FVT and 30 (2.4%) other forms. In 331 patients (41%), ablation was performed in sinus rhythm (SR). The mean follow-up period was 41.4 ± 10.7 months. Relapse of FVT occurred in 100 patients (10.7%). Among the 79 patients (8.3%) requiring a further procedure after the index ablation, 19 (2%) had further FVT relapses. Studies in which ablation was performed in FVT had similar success rate after multiple procedures compared to ablation in SR only (95.1%, CI_95% 92.2-97%, I² = 0% versus 94.8%, CI_95% 87.6-97.9%, I² = 0%, respectively). Success rate was numerically lower in paediatric-only series compared to non-paediatric cases (90.0%, CI_95% 82.1-94.6%, I² = 0% versus 94.3%, CI_95% 92.2-95.9%, I² = 0%, respectively).

Conclusion: Data derived from observational non-controlled case series, with low-methodological quality, suggest that catheter ablation is a safe and effective treatment for FVT, with a 93.5% success rate after multiple procedures. Ablation during FVT represents the first-line and most commonly used approach; however, a strategy of mapping and ablation during SR displayed comparable procedural results to actively mapping patients in FVT and should therefore be considered in selected cases where FVT is not inducible.

Keywords: Belhassen's tachycardia; Catheter ablation; Fascicular ventricular tachycardia; Idiopathic left ventricular tachycardia; Verapamil-sensitive tachycardia.

Publication types

Systematic Review

MeSH terms

Catheter Ablation / methods*
Catheter Ablation / trends
Cohort Studies
Humans
Observational Studies as Topic / methods
Prospective Studies
Retrospective Studies
Tachycardia, Ventricular / diagnosis
Tachycardia, Ventricular / epidemiology*
Tachycardia, Ventricular / surgery*
Treatment Outcome