Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardi in 57 Patients: Acute Success and Long Term Follow-up

Several centers have reported successful radiofrequency catheter ablation (RFCA) of ventricular tachycardi (VT) in patients (pts) without structural heart disease (idiopathic VT). Long term follow-up, however, has not been reported. We performed RFC in 57 pts (23 females) with mean age of 37 (range 6-64) years (yrs), and mean follow-up of 24 (range 1-51) months, including 30 pts with >2 yrs follow-up. Symptoms prior to ablation were presyncope (27 pts), palpitations (21 pts), syncope (8 pts), and chest pain (1 pt). The mean duration of symptomatic VT prior to ablation was 4.2 yrs (range 6wks.-25 yrs.). mean of 2.3 (range 1-6) drug trials failed to suppress VT. VT mapped to the right ventricular outflow tract (RVOT) in 36 of the 58 pts. Fourteen of 22 non-RVOT VTs mapped to the left ventricle (LV) and 8 mapped to the right ventricle (RV) (6 RV inflow; 2 RV free wall). Eight of 14 LV VTs were left posterior fascicular. RFC targeting non-fascicular VTs was guided by the earliest endocardial activation time and pace mapping. Fascicular VT was guided by early Purkinje potentials. Overall, RFC eliminated VT in 49 of 57 (86%) pts. In patients with RVOT VT, RFC eliminated VT in (100%) pts. Non-RVOT VT was successfully ablated in (63%) pts, including (88%) with left posterior fascicular VT. Two pts required 2 RFC sessions for success (1 RVOT and 1 non-RVOT). Two pts were treated for post-procedure pericardial effusions and one developed transient segmental wall motion abnormality. During follow-up, no patient had spontaneous or inducible VT or died. Conclusion: 1.) RFC for idiopathic VT is feasible and safe in large patient cohort. 2.) The success rate is higher for RVOT VT. 3.) Neither late recurrence nor proarrythmi has been observed.