Catheter Ablation of Right Ventricular Outflow Tract Tachycardia: Value of Defining Coronary Anatomy

Abstract

The major coronary arteries lie in close proximity of the RVOT, and their anatomic course should be taken into consideration during ablation of ventricular tachycardias arising from the RV outflow tract.

Catheter Ablation for Ventricular Tachycardia

“…The location of the discrete VT focus is suggested by the ECG, but the close anatomic relations of the RVOT, LV outflow tract, and their great vessels preclude definitive localization from the ECG alone. 68 Success rates for catheter ablation range from 85% to 97%. 61,69 Long-term follow-up is limited, but recurrence rates are generally low.…”

“…Although the left main coronary artery can be in close proximity to the posterior aspect of the RVOT, we are not aware of any cases of recognized coronary injury. 68 Infrequently, the focus is adjacent to the His bundle, where heart block is a risk of ablation. 75 Pulmonary Artery VTs VT can originate from sleeves of myocardium extending along the pulmonary artery, above the pulmonary valve, requiring ablation from within the pulmonary artery.…”

Elimination of Ventricular Arrhythmias Originating From the Anterior Interventricular Vein With Ablation in the Right Ventricular Outflow Tract

“…Although to the best of our knowledge coronary injury has not been reported with ablation in the RVOT, a study of gross pathology and computed tomography angiography measured a mean of 2.0 mm minimum distance between the RVOT and LAD. 4 The anatomic distance to the LAD is at a minimum 2 to 3 cm below the plane of the pulmonic valve. Thus, when targeting the AIV from the leftmost aspect of the septal RVOT, care should be taken to define the LAD location and to confirm a more superior site of ablation within the RVOT, using the right anterior oblique fluoroscopic projection (Figure [C]).…”

Idiopathic Outflow Tract Tachycardias

“…Having the limitations of activation and pace mapping in mind, ablation can be guided by electroanatomic mapping systems in difficult cases (Figure 4) [2-4, 28, 37-40]. Especially in patients with left OT-VT, the anatomy and the proximity of the coronary arteries should be taken into consideration before ablation [41]. Rarely, the site of origin of the OT-VT is epicardial.…”