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Zero-fluoroscopy catheter ablation for right ventricular outflow tract ventricular arrhythmias with a novel initial approach

Ba Van Vu, Thuc Cong Luong, Phong Dinh Phan, Thinh Duc Do, Kien Trung Hoang, Hung Manh Nguyen, Linh Thi Hai Ngo, Dung Tien Le, Nguyen Thao Phan, Huu Cong Nguyen

Background: Radio Frequency Catheter Ablation (RFCA) for Right Ventricular Outflow Tract Ventricular Arrhythmias (RVOT VAs) without fluoroscopy is increasingly performed but usually uses steerable catheter and intracardiac echocardiography, all of which may be too expensive or unavailable in many places. We introduced a novel approach which uses a non-steerable decapolar catheter to map the RVOT first without the assistance of echocardiography.

Methods and findings: A single center, prospective study in patients undergoing catheter ablation for RVOT VAs from May 2020 to November 2021. The approach includes first using a non-steerable decapolar catheter to fluorelessly map the RVOT via the superior vena cava, then the ablation catheter is advanced to the RVOT via the femoral vein followed the 3D-road map built by quadripolar catheter. A total of 43 consecutive patients with electrocardiographic features of RVOT VAs were enrolled. Mean age was 53.5 (23-83 years old), female/male rate was 3/1. Most of the patients presented with only PVC (79%), while 09 patients (20.9%) with non-sustained VTs, and only 01 patient with sustained VT. In 38 patients (88.4%) with total-zero fluoroscopy, acute success rate was 100% without any significant complication. In the rest 5 cases who required minimal fluoroscopy, acute success rate was 80%, the procedure failed in 1 patient due to the epicardial site of the VA foci. After a mean follow-up time of 4.8 ± 5.1 months, the long-term success rates of fluoroless ablation and combined ablation were 89.5% and 75%, respectively. Overall, the acute success rate reached 97.7%, the long-term success rate was 86.0%, and the recurrence rate was 11.6%.

Conclusion: Performing fluoroless RVOT approach using further non-steerable decapolar diagnostic catheter via SVC without echocardiography is feasible and safe. The non-steerable decapolar catheter could be used for activation mapping of RVOT VAs as an initial strategy of procedure.