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Utility of high resolution mapping to guide ablation of ventricular arrhythmias from the aortic sinuses of Valsalva

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Abstract

Purpose

Left ventricular outflow tract (LVOT) arrhythmias are commonly targeted from the aortic sinuses of Valsalva (SOV). Both presystolic potentials during ventricular arrhythmia (VA) and late diastolic potentials during sinus rhythm have been recognized as markers of successful ablation sites. The study aimed to evaluate the utility of high resolution mapping (HRM) with small and closely spaced electrodes for guiding ablation of VA from the SOV.

Methods

Seventeen patients with LVOT VA underwent HRM in the SOV with either PentaRay (13) or Orion (4) catheters. Ablation was guided by low amplitude high frequency potentials that were identified with HRM and tagged on the electroanatomic map.

Results

High frequency low amplitude potentials during sinus rhythm (late) or VA (early) were demonstrated with HRM in all 17 consecutive patients; while these potentials were either absent or usually had a far-field appearance in the recordings obtained at the same sites with a 3.5-mm standard ablation catheter. On intracardiac echocardiogram, sites with these potentials corresponded to the bases of the sinuses adjacent to the LV ostium. Ablation was acutely successful in 16 out of 17 patients. Significant reduction in VA burden (≥ 90%) was noted in 15 patients.

Conclusions

High frequency low amplitude potentials during sinus rhythm (late) and VA (early) are consistently recorded using HRM in the SOV in patients with VA arising from the aortic sinuses of Valsalva. Standard ablation catheters have limited resolution for detecting these potentials. HRM may potentially improve outcomes of ablation of VA originating from the aortic SOV.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Iowa Hospitals & Clinics, E-317C GH, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Faisal Matto, Troy E. Rhodes & Alexander Mazur

  2. Division of Cardiology, University of Kentucky College of Medicine, Bowling Green, KY, USA

    Dev Venugopal

  3. Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Prashant D. Bhave

Authors
  1. Faisal Matto
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  2. Dev Venugopal
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  3. Prashant D. Bhave
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  4. Troy E. Rhodes
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  5. Alexander Mazur
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Corresponding author

Correspondence to Alexander Mazur.

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The study was approved by the institutional review board.

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The authors declare no competing interests.

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Supplementary file1 (MP4 3572 KB) Video 1: suspected micro-reentrant circuit in the area of the right-left coronary cusp commissure

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Matto, F., Venugopal, D., Bhave, P.D. et al. Utility of high resolution mapping to guide ablation of ventricular arrhythmias from the aortic sinuses of Valsalva. J Interv Card Electrophysiol 66, 51–59 (2023). https://doi.org/10.1007/s10840-021-01040-9

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  • DOI: https://doi.org/10.1007/s10840-021-01040-9

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