Usefulness of the over‐the‐wire microelectrodes catheter in treatment of ventricular arrhythmia arising from the left ventricular summit

Abstract

Background This study was aimed to investigate the efficacy of the over‐the‐wire (OTW) microelectrodes catheter in coronary venous system (CVS) mapping and treatment of outflow tract ventricular arrhythmia (OTVA) arising from the vicinity of the left ventricular summit (LVS). Methods Consecutive 62 patients with idiopathic OTVA in whom the OTW microelectrodes catheter was routinely used for CVS mapping were analyzed. CVS mapping was performed for both main trunk (from great cardiac vein to anterior interventricular vein) and branches including the annular branch or septal branch. Results The earliest activation site (EAS) was within the CVS in 21 patients. Among them, the EAS was within the main trunk of the CVS in seven (33%) and within the branch of the CVS in 14 (67%) patients. Radiofrequency catheter ablation was started at an anatomically adjacent site to the EAS, which eliminated OTVA in 16 (76%) patients (the endocardial LVOT in 10 and the aortic sinus of Valsalva in six patients). For the remaining five patients with unsuccessful catheter ablation at an anatomically adjacent site, targeted OTVA was eliminated by catheter ablation at the EAS within the CVS in two patients and by chemical ablation with ethanol injection in one patient, resulting in the overall success rate of 90% (19/21). Conclusion The OTW microelectrodes‐guided ablation of OTVA from the vicinity of the LVS was effective. In maximizing the efficacy of ablation, CVS branch mapping is important since the earliest activation was commonly recorded not in the main trunk but within the branch of the CVS.

Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate

“…Alcohol ablation (AA) has been increasingly used as a bailout to ablation of intramural foci, especially with the increased use of epicardial and CVS activation mapping. [72][73][74] This method may be performed with ethanol delivered through a transarterial or retrograde coronary venous approach. [75][76][77] Limitations of the technique, particularly for transcoronary AA, are collateral injury to the conduction system and larger than intended infarction territory due to chemical reflux through collateral connections.…”

Potential feasibility of a novel over‐the‐wire microelectrode catheter for recording coronary sinus electrograms in patients with cardiac resynchronization therapy devices

“…Recently, a novel over‐the‐wire 2.7‐Fr microcatheter (EPstar Fix AIV; Japan Lifeline) has become available (Figure 1). Because of its small diameter and over‐the‐wire type structure, inserting it into the CS distal veins (i.e., anterior interventricular vein or communicating vein) is feasible and can be performed safely, particularly when treating outflow tract ventricular arrhythmias 4 . Based on its high selective performance in placement into small veins, we hypothesized that inserting the microcatheter into the CS would be feasible even in patients equipped with CRT devices.…”

Venous anatomy of the left ventricular summit region: Insights from high‐speed rotational retrograde angiography

“…2,6,7 Recent studies found that the earliest activation of LVS was commonly recorded within the branch of GCV rather than the main trunk, but they did not make a distinction between the LVA vein and LVS septal veins. 8 For better recognition and understanding intuitively for electrophysiologists, we call the veins near the junction of GCV-AIV and drain towards the basal superior septum region "LV summit veins," and the veins arising from distal AIV toward the interventricular groove "septal veins.…”