Transseptal versus transaortic approach for radiofrequency ablation in patients with cardioverter-defibrillator and electrical storm.
OBJECTIVE
Radiofrequency current ablation (RFCA) of ventricular tachycardia (VT) is usually performed using a retrograde transaortic approach. We compared the mapping accuracy, procedural course, safety, and results of VT ablation using transseptal and transaortic route.


METHODS
Twenty-one consecutive patients with ischemic cardiomyopathy and history of electrical storm underwent RFCA with electro-anatomic mapping system. In six patients, ablation was performed with transseptal approach (transseptal group); in 15, retrograde approach to the left ventricle was used (retrograde group).


RESULTS
The endocardial surface of the left ventricle was similarly accessible in both methods. Less detailed maps of interventricular septum were constructed with the use of transseptal approach. The RFCA success rate was similar in the transseptal and retrograde groups (83 vs. 80%, p = NS). The median procedural time was 112 min in transseptal vs. 145 min in the retrograde group; radiation exposure was 200 vs. 67 mGy, respectively (both p < 0.05), and fluoroscopy time was 22 vs.16 min (p = NS). During the 3-month follow-up, VT recurrence occurred in one patient in the transseptal group and in three patients in the retrograde group (p = NS).


CONCLUSIONS
Transseptal approach is an accurate, safe, feasible, and effective method of RF ablation in patients with malignant, recurrent ventricular arrhythmias. However, limited access to the septal regions with the use of this method has to be remembered. Transseptal approach may be considered as an alternative to the transaortic route in patients with contraindication to the latter.
Pluta
Slawomir
S
1st Department of Cardiology, Silesian Medical University, Silesian Center of Heart Diseases, Ul. Szpitalna 2, 41-800, Zabrze, Poland.
Lenarczyk
Radoslaw
R
Pruszkowska-Skrzep
Patrycja
P
Kowalski
Oskar
O
Sokal
Adam
A
Sredniawa
Beata
B
Mazurek
Michal
M
Kalarus
Zbigniew
Z
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome