Special considerations in mapping and ablation of focal ventricular arrhythmias originating from the left ventricular outflow tract in patients with a transcatheter aortic valve replacement

J Cardiovasc Electrophysiol. 2019 Nov;30(11):2640-2647. doi: 10.1111/jce.14175. Epub 2019 Sep 22.

Abstract

Transcatheter aortic valve replacements (TAVRs) have been increasingly performed in high-risk patients with severe aortic stenosis. Focal ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) can occur after a TAVR, and radiofrequency catheter ablation (RFCA) should be considered as a treatment option when those VAs are drug-refractory. There are specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT. However, if the anatomical background of the TAVR and LVOT VAs are well understood and the anatomical relationship between the TAVR device and LVOT is sufficiently evaluated, RFCA of LVOT VAs in patients with a TAVR should be safe and highly successful.

Keywords: left ventricular outflow tract; radiofrequency catheter ablation; transcatheter aortic valve replacement; ventricular arrhythmia.

Publication types

  • Review

MeSH terms

  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / surgery*
  • Arrhythmias, Cardiac / diagnostic imaging
  • Arrhythmias, Cardiac / surgery*
  • Catheter Ablation / methods*
  • Humans
  • Imaging, Three-Dimensional
  • Multidetector Computed Tomography / methods*
  • Transcatheter Aortic Valve Replacement / methods*
  • Ventricular Outflow Obstruction / diagnostic imaging
  • Ventricular Outflow Obstruction / surgery*