Selective Coronary Angiography via Irrigated Ablation Catheter for Aortic Cusp PVC Ablation

D. Althoff (Lübeck)¹, C.-H. Heeger (Hamburg)², H. Alessandrini (Lübeck)³, S. Hatahet (Lübeck)¹, C. Eitel (Lübeck)¹, S. S. Popescu (Lübeck)¹, K.-H. Kuck (Pfäffikon SZ)⁴, R. R. Tilz (Lübeck)^1
1Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; ²Asklepios Klinik Altona Kardiologie und Internistische Intensivmedizin Hamburg, Deutschland; ³Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; ⁴Cardiance Clinic Pfäffikon SZ, Schweiz

Background:
Premature ventricular contractions (PVC) originating from the aortic cusps can be treated effectively by catheter ablation. Periprocedural selective coronary angiography (CA) is recommended to assess the relation between the catheter tip and the coronary ostia and thereby reduce the risk of coronary injury. In this study, we analyzed the safety and feasibility of CA via the irrigated ablation catheter.

Methods:
In this single-center, retrospective study, data from all patients who underwent PVC ablation with periprocedural CA through the irrigation lumen of the ablation catheter between January 2018 and December 2024 at the University Hospital Lübeck in Germany were collected and recorded in an electronic database.

Results:
A total of 92 consecutive patients (40% female, n = 37) were included in the analysis. Five different ablation catheter models were used: THERMOCOOL SMARTTOUCH™ SF (n = 29, 32%), NAVISTAR™ (n = 27, 29%), QDOT MICRO™ (n = 26, 28%), TactiCath™ (n = 6, 7%), and TactiFlex™ (n = 4, 4%). Acute procedural success, defined as absence of PVCs at the end of the procedure, was achieved in 84 patients (91%). Air embolism occurred in 2 patients (2.2%) in 2018. In both cases, transient ST-elevations in leads II, III and aVF with temporary hypotension resolved completely within 3–5 minutes without further therapy; echocardiography excluded pericardial effusion and conventional coronary angiography of the RCA showed no stenosis or injury. Both procedures were completed successfully without permanent harm and no neurological symptoms were observed after discontinuation of sedation. In each case a NAVISTAR™ catheter had been used. No technical problems with the ablation catheter were observed after contrast injection. During follow-up (mean duration 16.5 ± 12.1 months), PVC recurrence, defined as >5% increase in PVC burden at 1-year Holter follow-up, was documented in 15 patients (16%).

Conclusion:
Periprocedural selective CA through the ablation catheter during PVC ablation in the region of the aortic cusps appears feasible, but larger multicenter, prospective, comparative studies are needed to definitively establish its safety profile.