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

Ling-Cong Kong; Tian Shuang; Zheng Li; Zhi-Guo Zou; Wen-Long Jiang; Jun Pu; Xin-Hua Wang

doi:10.3389/fcvm.2022.844320

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

Front Cardiovasc Med. 2022 Mar 2:9:844320. doi: 10.3389/fcvm.2022.844320. eCollection 2022.

Authors

Ling-Cong Kong¹, Tian Shuang¹, Zheng Li¹, Zhi-Guo Zou¹, Wen-Long Jiang¹, Jun Pu¹, Xin-Hua Wang¹

Affiliation

¹ Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Background: Catheter 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.

Methods: Forty-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.

Results: Sequential 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.

Conclusions: The systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.

Keywords: atrioventricular block; parahisian ventricular arrhythmias; radiofrequency ablation; systemic mapping approach; the septal leaflet of the tricuspid valve.