Right ventricular universal model for guidance of outflow tract ventricular arrhythmias ablation

Radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VA) originating from the right ventricular outflow tract (RVOT) is a well-established therapy. Traditionally, RFCA is guided using electroanatomical 3D mapping systems, which involve manual catheter navigation within cardiac chambers. This approach, while effective, may be time-consuming and may be associated with some risk of cardiac wall perforation. Thus, alternative mapping methods are welcomed to reduce procedural time and increase overall performance of RVOT-VA ablation.

To evaluate the safety, feasibility and efficacy of implementing a universal RVOT 3D model for ablation of idiopathic RVOT-VA.

Consecutive patients undergoing VA ablation with a universal RVOT 3D model (3D-MODEL group) were included in the study. Patients who underwent classic electroanatomical mapping served as controls (EAM group).

A total number of 228 patients were included in the study (143 women, age 50±16 years): 149 in the 3D-MODEL group and 79 in EAM group. Procedural time in the 3D-MODEL group was significantly shorter compared to the EAM group (38±14 min vs 81±40 min, p<0.001). Significant differences were also observed in ablation parameters between 3D-MODEL and EAM groups regarding power (40±8W vs 36±8W p<0.001) and radiofrequency time (248±172s vs 435±421 s, p<0.001). No significant difference in fluoroscopy time was observed between the 3D-MODEL and EAM groups (284±166 s vs 271±331 s, p=0.72). Acute, complete elimination of clinical VA was achieved in 132 (89%) of patients in the 3D-MODEL group vs 62 (78%) in the EAM group, while partial VA suppression was achieved in 17 (11%) patients in the 3D-MODEL group vs 15 (19%) in EAM group. In the remaining 2 (3%) patients from the EAM group no effect of ablation was observed during the procedure. Two cases of cardiac tamponade occurred, both in patients from the EAM group. During follow-up lasting 14±10 months, 82% of patients remained arrhythmia free (86% in 3D-MODEL group vs 76% in EAM group, p=0.66).

The use of a universal RVOT 3D modelling is feasible, safe and effective alternative to conventional electroanatomical mapping for ablation of idiopathic RVOT-VA

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