Optimization of Outflow-Tract Ventricular Arrhythmia Ablation Using a Universal Right Ventricle Model

Abstract

Introduction: The radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) originating from the right ventricular outflow tract (RVOT) is a well-established therapy. Traditionally, RFCA is guided using electroanatomical 3D mapping systems involving manual catheter navigation within cardiac chambers. While effective, this approach may be time-consuming, and it carries a potential risk of cardiac wall perforation. Although the risk is low, it cannot be underestimated. Therefore, alternative mapping methods are sought to reduce procedural times and improve the overall efficiency of RVOT-VAs ablation. Aim: To evaluate the safety, feasibility, and efficacy of a universal RVOT 3D model implementation for the ablation of idiopathic RVOT-VAs. Methods: Consecutive patients undergoing VA ablation supported with a universal RVOT 3D model (3D-MODEL group) were included in the study. The RVOT universal model in this group was created by processing DICOM images for the improved segmentation of anatomical structures, followed by production using 3D printing technology. Patients who underwent classic endocardial electroanatomical mapping served as controls (EAM group). Results: A total of 228 patients were included in the study (143 women, age 50 ± 17 years): 149 in the 3D-MODEL group and 79 in the EAM group. The acute complete elimination of clinical VAs was achieved for 133 (89%) of patients in the 3D-MODEL group vs. 65 (82%) in the EAM group (p = 0.14). The procedural time was significantly shorter in the 3D-MODEL group compared to the EAM group (38 ± 14 min vs. 80 ± 39 min, p < 0.001). A significant difference was also observed in the radiofrequency time between the 3D-MODEL and EAM groups (251 ± 176 s vs. 503 ± 425 s, p < 0.001). No significant difference in fluoroscopy time was found between the groups (284 ± 167 s vs. 260 ± 327 s, p = 0.49). Two cases of cardiac tamponade occurred, both in patients from the EAM group. During follow-up, lasting 14 ± 10 months, 87% of patients in the 3D-MODEL group and 75% in the EAM group remained arrhythmia-free (p = 0.45). Conclusions: The use of universal RVOT 3D modeling is a feasible, safe, and effective alternative to classic electroanatomical mapping in the ablation of idiopathic RVOT-VAs.