Anatomical Approach With Bipolar Ablation Between the Left Pulmonic Cusp and the Left Ventricular Outflow Tract for Left Ventricular Summit Arrhythmias.

Abstract Background Radiofrequency ablation (RFA) of ventricular arrhythmias (VAs) arising from the inaccessible basal region of the left ventricular summit (LVS) is challenging due to proximity to coronary vessels, epicardial fat and poor RF delivery within the distal coronary venous system. Objective We describe the outcomes of an anatomical approach for inaccessible LVS-VAs using bipolar RF (Bi-RFA) delivered from the anatomically adjacent left pulmonic cusp (LPC) to the opposite LV outflow tract (LVOT). Methods From 3 centers we reviewed patients (pts) who underwent Bi-RFA for inaccessible LVS-VAs refractory to conventional RFA using an anatomical approach targeting the adjacent LPC ("reversed U" approach) with catheter tip pointing inferiorly within the LPC and LVOT. Results A total of 7 pts (59±12 years, 3 females) underwent Bi-RF from the LPC to the LVOT for LVS-VAs after ≥1 failed conventional RFA. Bi-RFA (power 36±7 W, duration 333±107s) resulted in VAs suppression in 5 out of 7 pts. In 2 cases Bi-RFCA was successfully performed using dextrose-5% in water (D5W). No complications occurred. After a mean follow-up of 14±6 months, no recurrent VT was documented in 2/2 pts with baseline VT and a mean 84% reduction in PVC burden (31±13% vs 4±5% PVC/d; p=0,0027) was documented in others. Conclusion In pts with LVS-VAs arising from the inaccessible region and refractory to conventional RFA, an anatomical approach utilizing Bi-RFA from the LPC and opposite LVOT is an effective alternative approach.