Catheter ablation for fascicular ventricular tachycardia: A systematic review

Abstract

Introduction: Catheter ablation has been evaluated as treatment for fascicular ventricular tachycardia (FVT) in several single-centre cohort studies, with variable results regarding efficacy and outcomes. Methods: A systematic search was performed on PubMed, EMBASE and Cochrane database (from inception to November 2017) that included studies on FVT catheter ablation. Results: Thirty-eight observational non-controlled case series comprising 953 patients with FVT undergoing catheter ablation were identified. Three studies were prospective and only 5 were multi-centre. Eight-hundred and eighty-four patients (94.2%) had left posterior FVT, 25 (3.4%) left anterior FVT and 30 (2.4%) other forms. In 331 patients (41%), ablation was performed in sinus rhythm (SR). The mean follow-up period was 41.4±10.7 months. Relapse of FVT occurred in 100 patients (10.7%). Among the 79 patients (8.3%) requiring a further procedure after the index ablation, 19 (2%) had further FVT relapses. Studies in which ablation was performed in FVT had similar success rate after multiple procedures compared to ablation in SR only (95.1%, CI95%92.2-97%, I2=0% versus 94.8%, CI95%87.6-97.9%, I 2 =0%, respectively). Success rate was numerically lower in paediatric-only series compared to nonpaediatric cases (90.0%, CI95%82.1-94.6%, I 2 =0% versus 94.3%, CI95%92.2-95.9%, I 2 =0%, respectively). Conclusion: Data derived from observational non-controlled case series, with lowmethodological quality, suggest that catheter ablation is a safe and effective treatment for FVT, with a 93.5% success rate after multiple procedures. Ablation during FVT represents the firstline and most commonly used approach; however, a strategy of mapping and ablation during SR displayed comparable procedural results to actively mapping patients in FVT and should therefore be considered in selected cases where FVT is not inducible.

Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience

“…Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg (22-86), and the mean age was 13.6 ± 2.5 years (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The indication for ablation was decreased left ventricular systolic function, revealed by echocardiography (EF: 45%) in one patient due to incessant fascicular tachycardia.…”

“…However, compared to adult patients, the success rate was significantly lower in paediatric studies (90% versus 94.3%). 7 Use of a threedimensional electroanatomic mapping system varied significantly among studies included in the review. In our procedures, threedimensional electroanatomic mapping systems helped confirm the exact catheter position prior to ablations, allowing us to label the location of ablation lesions on the three-dimensional map.…”

Recognizing Belhassen Ventricular Tachycardia and Preventing Its Misinterpretation as Supraventricular Tachycardia: An Unusual Case Report

“…IV verapamil is considered the gold standard in the initial emergent management, followed by long-term catheter ablation (CA) [9]. CA is effective in curing almost 90% of the disease in the long term [10]. In patients who are not willing to undergo CA, oral verapamil has been less successful for the permanent cessation of the arrhythmia but is likely the best option for outpatient management [5].…”

Sex differences in the origin of Purkinje ectopy-initiated idiopathic ventricular fibrillation

“…31 By combining results from 8 studies with 65 patients affected by MEPPC syndrome, female sex slightly predominates (60%). In the largest review of 953 patients with fascicular VT undergoing catheter ablation, Creta et al 32 showed that male sex was predominant (82%), which may appear in discrepancy with LV PurkEs predominating in women. However, fascicular VTs are mainly attributable to reentry with conduction disturbance in the Purkinje fascicles and myocardium while ectopic triggers mainly involve triggered activity mechanisms.…”