Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Initial Human Experience.

BACKGROUND

Catheter ablation for ventricular arrhythmias is limited by a high first-attempt failure rate approaching 50% to 60%. Failure appears driven by physical inaccessibility of mapping and ablating deep intramyocardial substrate. VINTAGE (Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms) is a novel procedure to steer guidewires within the walls of the beating left ventricle (LV) from a right ventricular entry point and deliver a deep intramural ablation electrode anywhere within the LV.

OBJECTIVES

The objective of this work is to assess the provisional safety and efficacy of VINTAGE intramyocardial navigation and ablation as first offered to patients.

METHODS

This is a retrospective review of all patients who underwent VINTAGE at Emory University in the practice of medicine for recurrent ventricular tachycardia (VT) or a high burden of premature ventricular contractions (PVC) despite prior ablation and antiarrhythmic drugs.

RESULTS

Thirteen patients (39% female) with a median of 2 (IQR: 1-3) prior ablations underwent VINTAGE (1 repeat, total 14 procedures), of whom 5 (39%) had VT and 8 (62%) had PVCs. Arrhythmias originated in the LV summit (n = 3), basal-lateral wall (n = 4), septum (n = 3), inferior wall (n = 1), and papillary muscles (n = 2). Technical success was 100%. At median follow-up of 150 days, clinical success by patient (reduction in VT therapy of PVC burden >80%) was 85% (100% for VT and 75% for PVC). Four of 5 (80%) of the VT cohort were free from appropriate implantable cardiac defibrillator shocks, appropriate antitachycardia pacing, or hospital admission due to recurrent VT. One suffered a nondisabling stroke and another a vascular complication.

CONCLUSIONS

VINTAGE was effective at creating intramural ablation lesions and treating ventricular arrhythmias arising from targets traditionally considered inaccessible from the endocardium and epicardium, including infarcted myocardium.