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

Abstract Background 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. Objective To evaluate the safety, feasibility and efficacy of implementing a universal RVOT 3D model for ablation of idiopathic RVOT-VA. Methods 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). Results 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). Conclusions The use of a universal RVOT 3D modelling is feasible, safe and effective alternative to conventional electroanatomical mapping for ablation of idiopathic RVOT-VA .