Catheter Ablation of Premature Ventricular Complexes Exclusively by A 3D Electroanatomic Pace-Mapping Software Technique: Long-Term Follow-Up

Introduction/Objective: Ablation of premature ventricular complexes (PVCs) is a challenge in routine electrophysiology. Results depend on factors such as location, tools, and technologies available. The study aimed to analyze the exclusive use of the pace-mapping technique with module of Score MapTM (SM) Software of Ensite Velocity/Precision and evaluate long term success.

Methods/Results: Forty-three procedures were retrospectively analyzed between March 2018 and August 2019. Ablation was conducted with an irrigated tip catheter with a power of 20–40 W and a pump flow rate of 30ml/min. Mapping with a duodecapolar was conducted in 36 (83.72%) cases, and the HDGrid catheter was used in seven (16.28%) cases. The patients included 22 (51.16%) females, and the mean age was 51.65 years (19–78). Thirty-five patients (81.40%) had hypertension; six (13.95%) had chronic coronary disease; four (9.30%) had myocarditis; two (4.65%) had diabetes; and none had implanted defibrillators. Mean ejection fraction was 63.17% (47.35%–77.32%). Average radiofrequency time was 597.72 (176–1356) s, and mean X-Ray time was 7.74 min. During the procedure, median SM was 93.81% (84%–100%) and only seven (18.42%) ablations were considered unsuccessful due to maintenance of extrasystoles or reduction of PVCs. After a follow-up of 19.58 (12–30) months, 37 (86.05%) patients achieved success. Failure was observed in cases with an SM score ≤ 92%, ablation cases with conscious sedation, female sex, both side ventricle ablation and associated with cardiac veins, and more than 900 seconds of RF application.

Conclusion: Score MapTM is useful as an exclusive technique for ablation of premature ventricular complexes with very good acute success and low complications, and an SM score higher than 92% had high long-term success. Failure was related to conscious sedation, female gender, both side ventricle with cardiac veins ablation, and longer radiofrequency time.

Keywords: Premature ventricular beats, catheter ablation, pace-mapping, electroanatomic mapping, activation map.