Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China.
Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Rd. Xicheng District, 100037 Beijing, China.
Europace. 2023 Nov 2;25(11). doi: 10.1093/europace/euad339.
Traditional ablation strategies including targeting the earliest Purkinje potential (PP) during left posterior fascicular (LPF) ventricular tachycardia (VT) or linear ablation at the middle segment of LPF during sinus rhythm are commonly used for the treatment of LPF-VT. Catheter ablation for LPF-VT targeting fragmented antegrade Purkinje (FAP) potential during sinus rhythm is a novel approach. We aimed to compare safety and efficacy of different ablation strategies (FAP ablation vs. traditional ablation) for the treatment of LPF-VT.
Consecutive patients with electrocardiographically documented LPF-VT referred for catheter ablation received either FAP ablation approach or traditional ablation approach. Electrophysiological characteristics, procedural complications, and long-term clinical outcome were assessed. A total of 189 consecutive patients who underwent catheter ablation for LPF-VT were included. Fragmented antegrade Purkinje ablation was attempted in 95 patients, and traditional ablation was attempted in 94 patients. Acute ablation success with elimination of LPF-VT was achieved in all patients. Left posterior fascicular block occurred in 11 of 95 (11.6%) patients in the FAP group compared with 75 of 94 (79.8%) patients in the traditional group (P < 0.001). Fragmented antegrade Purkinje ablation was associated with significant shorter procedure time (94 ± 26 vs. 117 ± 23 min, P = 0.03) and fewer radiofrequency energy applications (4.1 ± 2.4 vs. 6.3 ± 3.5, P = 0.003) compared with the traditional group. One complete atrioventricular block and one left bundle branch block were seen in the traditional group. Over mean follow-up of 65 months, 89 (93.7%) patients in the FAP group and 81 (86.2%) patients in the traditional group remained free of recurrent VT off antiarrhythmic drugs (P = 0.157).
Left posterior fascicular-ventricular tachycardia ablation utilizing FAP and traditional ablation approaches resulted in similar acute and long-term procedural outcomes. Serious His-Purkinje injury did occur infrequently during traditional ablation. The use of FAP ablation approach was associated with shorter procedure time and fewer radiofrequency energy applications, especially for non-inducible patients.
传统的消融策略包括在左后间隔（LPF）室性心动过速（VT）期间靶向最早的浦肯野电位（PP），或在窦性心律期间在 LPF 的中段进行线性消融，常用于治疗 LPF-VT。针对窦性心律期间碎裂的顺行浦肯野（FAP）电位的导管消融是一种新的方法。我们旨在比较不同消融策略（FAP 消融与传统消融）治疗 LPF-VT 的安全性和疗效。
连续 189 例心电图记录的 LPF-VT 患者接受了导管消融治疗，分为 FAP 消融组和传统消融组。评估电生理特征、程序并发症和长期临床结果。共纳入 189 例接受 LPF-VT 导管消融的连续患者。95 例患者尝试 FAP 消融，94 例患者尝试传统消融。所有患者均实现了急性消融成功，消除了 LPF-VT。FAP 组中有 11 例（11.6%）患者出现左后间隔阻滞，而传统组中有 75 例（79.8%）患者出现左后间隔阻滞（P < 0.001）。与传统组相比，FAP 消融组的手术时间更短（94 ± 26 分钟 vs. 117 ± 23 分钟，P = 0.03），射频能量应用次数更少（4.1 ± 2.4 次 vs. 6.3 ± 3.5 次，P = 0.003）。传统组中出现完全性房室传导阻滞 1 例，左束支传导阻滞 1 例。平均随访 65 个月后，FAP 组有 89 例（93.7%）患者和传统组有 81 例（86.2%）患者在停用抗心律失常药物后无复发性 VT（P = 0.157）。
利用 FAP 和传统消融方法治疗左后间隔-室性心动过速的急性和长期程序结果相似。在传统消融过程中，希氏-浦肯野系统严重损伤并不常见。FAP 消融方法的应用与手术时间更短和更少的射频能量应用相关，特别是对于非诱发性患者。
