Abstract 15835: Safety of Catheter Ablation of Ventricular Arrhythmias Originating from the Coronary Cusps Guided by Intracardiac Echo: A Multicenter Experience
Introduction. Coronary artery damage is a potential complication of radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) arising from the coronary cusps. Coronary angiography is usually performed to assess the distance between the ablation catheter tip and the ostia of the coronary vessels in order to avoid coronary artery damage. Intracardiac echocardiography (ICE) is a valuable tool to detect the origin of the coronary arteries, assist catheter positioning and monitor radiofrequency delivery. We report the safety of ICE-guided VAs ablation arising from the coronary cusps in a multicenter experience of high-volume VAs ablation centers.
Methods. 122 consecutive patients (age 59 ± 13 years, 62% males) underwent RFCA of VAs arising from the coronary cusps. Mapping and ablation were performed with an open-irrigated catheter, guided by three-dimensional electroanatomic mapping. Periprocedural ICE monitoring was adopted to assist catheter positioning within the coronary cusp, detect the origin of the coronary arteries, and monitor radiofrequency delivery. In case of suboptimal visualization of the coronary arteries, coronary angiography was performed.
Results. Overall, 76 (62%) patients presented with VAs arising only from the left coronary cusp, 17 (14%) with VAs arising only from the right coronary cusp, and 29 (24%) had VAs arising from both the right and left coronary cusps. A total of 151 ablation procedures were performed, 105 (70%) from within the left coronary cusp, and 46 (30%) from within the right coronary cusp. ICE was the only imaging modality in all 151 cases of left coronary cusp ablation, and in 44/46 (96%) cases of right coronary cusp ablation. In this group, coronary angiography was required in 2 (4%) cases due to failure to image the right coronary artery ostium. No periprocedural complication was observed.
Conclusions. Catheter ablation of VAs arising from the coronary cusps guided by ICE is safe. Such approach abolishes the need for intraprocedural coronary angiography in all cases of left coronary cusp ablation, and in the majority of right coronary cusp ablations.
- © 2012 by American Heart Association, Inc.