loading page

Transseptal approach versus retrograde aortic approach in mapping and ablation of ventricular arrhythmias from anterolateral papillary muscles
  • +7
  • Chen-Xi Jiang,
  • Shao-Long LI,
  • Mengmeng Li,
  • Ribo Tang,
  • Caihua Sang,
  • Wei Wang,
  • Jianzeng Dong,
  • Deyong Long,
  • Paul Zei,
  • Chang Sheng Ma
Chen-Xi Jiang
Capital Medical University
Author Profile
Shao-Long LI
Yan’an Hospital affiliated to Kunming Medical University
Author Profile
Mengmeng Li
Capital Medical University
Author Profile
Ribo Tang
Capital Medical University
Author Profile
Caihua Sang
Capital Medical University
Author Profile
Wei Wang
Capital Medical University
Author Profile
Jianzeng Dong
Capital Medical University
Author Profile
Deyong Long
Capital Medical University

Corresponding Author:dragon2008@vip.sina.com

Author Profile
Paul Zei
Brigham and Women's Hospital Department of Medicine
Author Profile
Chang Sheng Ma
Capital Medical University
Author Profile

Abstract

Background: The anterior and lateral position of the anterolateral papillary muscle (ALPM) has found to be reached with better catheter stability and less mechanical bumping via the transseptal (TS) compared to the retrograde aortic (RA) approach. Aim: To compare the TS and RA approaches on mapping and ablation of ventricular arrhythmias (VAs) arising from ALPMs. Methods: Thirty-two patients with ALPM-VAs undergoing mapping and ablation via the TS approach were included and compared with 31 patients via the RA approach within the same period. Acute success was compared, as well as other outcomes including misinterpreted mapping results due to bumping, radiofrequency (RF) attempts, procedural time and success rate at 12 months’ follow-up. Results: Acute success was achieved in more cases in the TS group (96.4% vs 72.0%, P=0.020). During activation mapping, bump-provoked premature ventricular complexes (PVCs) misinterpreted as clinical PVCs were more common in the RA group (30.0% vs 58.3%, P=0.036), leading to more RF attempts (3.5±2.7 vs 7.2±6.8, P=0.006). Suppression of VAs were finally achieved in the unsuccessful cases by changing to the alternative approach, but the procedural time was significantly less in the TS group (90.0±33.0 vs 113.7±41.1min, P=0.027) with less need to change the approach, although follow-up success rates were similar (75.0% vs 71.0%, P=0.718). Conclusion: A TS rather than RA approach as the initial approach appears to facilitate mapping and ablation of ALPM-VAs, specifically by decreasing the possibility of misleading mapping results caused by bump-provoked PVC, and increase the acute success rate thereby.
Submitted to Journal of Cardiovascular Electrophysiology
03 Apr 2024Assigned to Editor
03 Apr 2024Submission Checks Completed
28 Apr 2024Review(s) Completed, Editorial Evaluation Pending
29 Apr 2024Editorial Decision: Revise Minor
26 May 2024Review(s) Completed, Editorial Evaluation Pending
27 May 2024Editorial Decision: Accept