Introduction
Radiofrequency catheter ablation (RFCA) is an effective and safe therapy for idiopathic ventricular arrhythmias (VAs). However, the ablation of VAs originating from the left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein (DGCV-AIV) can be challenging because of the complex anatomic structures of this region (adjacent to coronary arteries) and difficulty in manipulation of the ablation catheter in the small-lumen and tortuous coronary venous system[1,2].
It is reasonable to assume that any approach, which could assist ablation catheter going through the anatomic obstacles in the coronary venous system and aid catheter tip reaching more distal portion of DGCV-AIV, would improve the success rate of RFCA. Nevertheless, up to now, no systemic studies investigated the most appropriate manipulation approach for RFCA of VAs arising from DGCV-AIV.
Recent studies revealed that application of Swartz sheath could improve stability of catheter manipulation and enhance mapping and ablation efficiency in RFCA for VAs, for example, reversed U-curve technique of ablation catheter with the support of Swartz sheath for PSCs VAs[3], reversed S-curve technique of ablation catheter with the support of Swartz sheath close to the fossa ovalis for endocardial LV summit VAs[4]. Thus, we doubt whether the Swartz sheath support approach could be utilized in RFCA of DGCV-AIV VAs to achieve a more efficient ablation.
In this study, we aimed to evaluate the value and safety of the Swartz sheath support approach in mapping and ablation of DGCV-AIV VAs.