• Pol. Arch. Med. Wewn. · Jun 2019

    Multicenter Study Comparative Study

    Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry).

    • Katarzyna Styczkiewicz, Bartosz Ludwik, Janusz Śledź, Magdalena Lipczyńska, Beata Zaborska, Tomasz Kryński, Karol Deutsch, Aleksandra Morka, Piotr Kukla, Marek Styczkiewicz, Piotr Kułakowski, and Sebastian M Stec.
    • Department of Cardiology, Brzozów Specialist Hospital, Subcarpathian Cancer Center, Brzozów, Poland
    • Pol. Arch. Med. Wewn. 2019 Jun 28; 129 (6): 399-407.

    IntroductionRadiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long‑ term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported.ObjectivesThis aim of the study was to determine the short- and long‑ term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening.Patients And MethodsThis was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34-64) from the "Electra" Registry (2005-2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero‑fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy‑ based RFA. Data on clinical history, complications after RFA, echocardiography, and 24‑ hour Holter monitoring were collected. The follow up was 12 months or longer.ResultsThere were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58-95), median follow‑ up, 32 months (IQR, 12-70). Acute and long term procedural success rates were 93% and 86%, respectively. The long‑ term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long‑ term follow‑up, no abnormalities were found within the aortic root.ConclusionsAblation of VA within the aortic cusps is safe and effective in long‑ term follow up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities.

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