MID TERM RESULTS OF FOCAL VENTRICULAR ABLATION AT TAM DUC HEART HOSPITAL

MID-TERM RESULTS OF FOCAL VENTRICULAR ABLATION AT TAM DUC HEART HOSPITAL FROM APRIL 2014 TO SEPTEMBER 2016 Do Van Buu Dan, MD On behalf of EP team of Tam Duc Heart hospital... OBJECTIV

MID-TERM RESULTS OF FOCAL VENTRICULAR ABLATION AT TAM DUC HEART HOSPITAL

FROM APRIL 2014 TO SEPTEMBER 2016

Do Van Buu Dan, MD

On behalf of EP team of Tam Duc Heart hospital

BACKGROUND

• Focal ventricular arrhythmia (VAs) is pretty

common in clinical practice, originating from RVOT, LVOT, papillary muscle…

• Clinical presentation varies from PVCs,

non-sustained to non-sustained VT

• Symptoms could be slightly symptomatic

(palpitation, dizziness, shortness of breath) or syncope/syncope

pre-• May even induce cardiomyopathy

BACKGROUND (2)

• Average effectiveness of medication is #50%

• RCFA is effective for medication-refractory VAs with the successful rate up to 90%

• The results of RCFA differs among centers in Vietnam Some reported successful rate only about 50%

OBJECTIVES

• Investigating the results of RFCA for 50 focal VA

patients in Tam Duc Heart hospital from April 2014

to September 2016

• Identifying factors predicting success in mid-term follow-up

Method

• Between April 2008 and October 2016

• A total of 50 consecutive patients idiopathic focal VA have been enrolled

Inclusion criteria:

- Symptomatic VA refractory to at least one AAD

- Asymptomatic PVC with PVC burden >20% total heart beats/Holter ECG

EP study and mapping

• After obtaining informed consent from patients,

EPS was performed for all patients in the fasting

and non-sedated state

• Before the study, all AADs except amiodarone were discontinued for at least 5 half-lives

• In the absence of spontaneous VA, ventricular

stimulation protocol was performed with or

without Isoproterenol infusion (1–4 μg/min)

EP study and mapping (2)

• The localization of arrhythmogenic foci was

performed conventionally or by using 3D mapping system (EnsiteNavX™, St Jude Inc., St Paul, MN,

USA)

• Activation mapping, defining the earliest activation (EA) signals,

• And/or pace mapping by comparing the 12-lead

QRS morphology of paced PVCs with clinical PVCs aiming for at least 11/12 leads matching

Activation mapping

EA = 32ms

Pace mapping

11/12 match

Conventional vs 3D mapping

EP study and mapping (3)

• RF energy was delivered in a

temperature-controlled mode at 60oC with pulse duration of 60 seconds; maximal power was 50 Watts for non-

irrigated catheter and 30-35 Watts for irrigated

EP study and mapping (4)

• Acute success: defined as complete elimination of

spontaneous/inducible VAs under isoprenaline IV, during 30 minutes monitoring

• All patients underwent a 24-hour ECG monitoring after ablation

• Recurrences: defined as recurrence of sustained VT,

non-sustained VT, or >1000 PVCs on 24-hour Holter ECG.*

Am J Cardiol 1999;84:1266-8, A9

• P < 0.05 was considered significant

• SPSS 20.0 (Chicago, IL, USA) was used

ECG/ Holter ECG recordings

AADs used before RFCA

Parameters of electrophysiological study and mapping

• VT/PVC QRS duration (msec) 134±7

• Earliest activation time (msec) 34.8±5.6

• Perfect pace map (12/12) 30 (60%)

RESULTS (N=50)

Fluoroscopy time Conventional vs 3D mapping

Comparison between patients with and without recurrences (N=44)

Non-recurrent Recurrent P value

Comparison between patients with and without recurrences (N=44)

No recurrences Recurrences P value

No recurrences Recurrences P value

No recurrences Recurrences P value

No recurrences Recurrences P value

No recurrences Recurrences P value

• Fluoroscopy time (min) 25.7±14.9 27.9±14.0 0.723

Comparison between patients with and without recurrences (N=44)

Kaplan-Meier Non-recurrent curve

Perfect vs Non-perfect pace map

ROC curve analysis

• The optimal cutoff values for identifying

non-recurrent group were generated from

receiver-operating characteristic (ROC) curves The earliest activation time (EA) was used for determining the cutoff value according to the greater area under

the ROC curve

• Cutoff values of EA ≥ 31.5ms could differentiate the non-recurrent group from recurrent group, as

manifested by a sensitivity of 81% and specificity of 71% (AUC 0.79)

CONCLUSIONS

• RFCA is the treatment of choice for patients with VAs refractory to AADs

• Procedure is pretty safe and effective

• After 8.5 months FU, the rate of free-from-

recurrence was 84.1%

• Obtaining EA ≥31.5ms or perfect pace map before applying RF energy to avoid recurrence

Thank you for your attention