Long Term Success Rate Of Catheter Ablation For Ventricular Arrhythmias Originate From Tricuspid Annulus

ObjectiveThis study investigated the long-term success rate of catheter ablation for premature ventricular complex(PVC)and ventricular tachycardia(VT)originating from tricuspid annulus(TA).MethodsFrom January 2013 to December 2016,43 patients with idiopathic PVC/VT originating from tricuspid annulus were observed retrospectively in cardiology department of the first affiliated hospital of Nanjing medical University,Three dimensional electroanatomical mapping was used to construct the TA and the right ventricular geometric model.The earliest activation point of PVC/VT was traced by activation mapping.Ablation was carried out in a temperature controlled mode with the power set to 30-40 W,temperature set at 55 degrees,and ablation time to 60 seconds / point.If irrigated catheter was used,the power set to 30-40 W,temperature set at 43 degrees,the flow with 17 ml/min and ablation time to 30 seconds /point.Follow-up was done at 3 months' post-operation and then,every 6 months.12 lead electrocardiogram and 24-hour ambulatory electrocardiogram monitoring were required at each follow-up.ResultsMapping showed that among the 43 patients with PVC/VT,22(52.27%)had a free wall(FW),and 21(47.73%)septal origins.There was no significant difference of activation time at the target site,energy,ablation time,x-ray time and dose between two groups.Ablation temperature was lower in FW group than septum group(39.32 ± 6.31? vs.43.45 ± 4.65 ?,P = 0.03),however,irrigated flow was higher in FW group than septum group(11.86 ± 9.27 ml/min vs.4.56 ± 8.15 ml/min,P = 0.02);Procedure time was longer in septum group than FW group(110.43 ± 45.59 min vs.85.43 ± 27.90 min,P = 0.04).Ablation was successful in 39(90.7%)cases,and the success rate was higher in FW group than septum group(100% vs.80.95%,P = 0.03).The remaining 4 patients had septal origins,with 3 anterior septum and 1 posterior septum.No serious complications such as pericardial tamponade were observed during the operation.The average follow-up was 45.54 ± 14.04 months.PVC recurred in 4 patients: 2 in posterior free wall,1 in middle free wall,1 in middle septum,and the second ablation were successful in 3 patients,the other one refused second ablation.ConclusionsCatheter ablation is a safe and effective method for the treatment of TA-PVC/VT.A 3.8 years' follow-up showed that the success rate of TA-PVC/VT ablation was 81.40%.