Abstract
BACKGROUND For ventricular
arrhythmias (VAs) originating from the left ventricular epicardium
adjacent to the transitional area from the great cardiac vein to the
anterior interventricular vein (DGCV-AIV), the most efficient catheter
manipulation approach has not been fully elucidated.
OBJECTIVE This study aimed to investigate a more appropriate
catheter manipulation approach for DGCV-AIV VAs.
METHODS One hundred twenty-three consecutive patients with
DGCV-AIV VAs were retrospectively analyzed. All these patients were
firstly mapped and ablated by conventional approach (Non-Swartz sheath
support (NS) approach). When target sites not been reached, Swartz
sheath support (SS) approach was attempted. If target sites still
unreached, the hydrophilic coated
guide wire and left coronary angiographic catheter-guided deep
engagement of Swartz sheath in GCV to support ablation catheter was
performed.
RESULTS A total of one hundred three VAs (103/123, 83.74%)
were successfully eliminated in DGCV-AIV. By NS approach, the tip of
catheter reached DGCV in 39.84% VAs (49/123), reached target sites in
35.87% VAs (44/123), and achieved successful ablation in 30.89% VAs
(38/123), which was significantly lower than by SS approach (88.61%
(70/79), 87.34 % (69/79), and 84.81% (67/79),P<0.05 ). In left anterior oblique (LAO) view, angle
between DGCV and AIV<83° indicated an inaccessible AIV by
catheter tip with a predictive value of 94.5%. Width/height of coronary
venous system>0.69 more favored a SS approach with a
predictive value of 87%.
CONCLUSION For RFCA of VAs arising from DGCV-AIV, the SS
approach facilitates the catheter tip achieve target sites and
contributes to a successful ablation.
KEYWORDS Distal great cardiac vein, Anterior interventricular
vein, Summit-communicating vein, Ventricular arrhythmias, Radiofrequency
catheter ablation, Swartz sheath