Background and objectives: Idiopathic ventricular extrasystoles (VES)/tachycardias originating from outflow tract (OT) are very commonly encountered in clinical practice. Ablations of these arrhythmias can be very difficult and time-consuming due to intermittent nature and complex anatomy of OT even if an expensive 3D electroanatomical mapping system is used. In this case report, we would like to present long term follow-up of 29 consecutive patients who underwent VPS ablation performed with conventional technique using pace-mapping and the earliest activation.
Results: Of 29 patients, the mean age was 51.1±15.4 years and 67%(16) of them were female. All the patients were symptomatic and in sinus rhythm before the procedure and the mean daily VES burden percentage was 13.6±12.2. Using conventional mapping, the earliest activation spots were identified in RVOT free wall (8, 27%), RVOT septum (14, 48%), left coronary cuspid (2, 6.9%), LVOT (2, 7%) and aortomitral continuity (3, 10%). Mean time of procedure was 96.7±33.1 min and mean RF time was 10.6±9.2 min. Acute procedural success was 93% (27) and at 1-month visit, all but 4 patients (86.2%) had significant symptomatic improvement with no symptoms at all (%86.2). While 23 patients were completely asymptomatic with no need for drugs at 6-month visit, the symptomatic status was unchanged in 5 and was deteriorated in one patient who had a change in drug regimen. Aside from 2 vascular complications as mild inguinal hematoma formation and 1 minimal pericardial effusion, no other major complication was observed.
Conclusions: Ablation of idiopathic ventricular extrasystole/tacchycardia performed with a conventional technique still constitutes a safe and reliable method, and may be tried before the utilization of a 3D-mapping system as the initial choice.