Combined approach improves the outcomes of catheter ablation of idiopathic ventricular arrhythmias originating from the vicinity of tricuspid annulus.

BACKGROUND: Ablation of idiopathic ventricular arrhythmias (VAs) originating from the vicinity of tricuspid annulus (TA) is often unsuccessful via inferior approach. We report the initial experience with catheter ablation of VAs arising from the vicinity of the TA via superior approach.
METHODS: We retrospectively studied 36 patients with VAs arising from the vicinity of TA who underwent ablation via transfemoral vein approach first. If patients had a failed prior ablation or VAs recurred during follow-up, they were referred for repeat ablation via transsubclavian vein approach.
RESULTS: Among 36 patients, 11 (30.6%) patients (five failed during the index procedure and six recurred during the follow-up) were assigned to perform repeat ablation via the transsubclavian vein approach. After the final procedure two patients recurred again, and success rate increased from 69.5% (25/36) to 94.4% (34/36). Amplitudes of the atrial electrograms of all successful ablation sites via the transsubclavian vein approach was <0.036 mV.
CONCLUSIONS: The transsubclavian vein approach plus transfemoral vein approach improve the outcomes of catheter ablation of idiopathic VAs originating from the vicinity of TA. The transsubclavian vein approach is a feasible alternative for VAs, which has been refractory to ablation via the inferior approach. ©2014 Wiley Periodicals, Inc.