Multielectrode mapping for premature ventricular contraction ablation – A prospective, multicenter study

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Highlights

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    This is the largest study evaluating the use of the PentaRay catheter for premature ventricular contraction ablation.

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    The use of the PentaRay allowed a 7x higher number of LAT points, which led to a significant reduction in procedure time.

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    Patients performing mapping with the multipolar catheter had a higher freedom from ventricular arrhythmia at 1-year.

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    The use of the PentaRay catheter was an independent predictor of success.

Abstract

Purpose

We aim to evaluate whether the use of a multielectrode mapping catheter could lead to higher efficacy of premature ventricular contraction (PVC) ablation.

Methods

Prospective, multicenter nonrandomized study of consecutive patients referred for PVC ablation from January 2018 to June 2021. Patients were separated into two groups: activation map performed with the PentaRay catheter (Study group) or with the ablation catheter (Control group). PMF software was used in both groups. Procedural endpoints and 1-year freedom from ventricular arrhythmia were assessed.

Results

During the enrollment period 136 patients (60% males, mean age of 55 ± 17 years, 60% left-sided origin) fulfilled the inclusion criteria - 68 patients in each group. Patients in the Study Group had a sevenfold higher number of acquired activation points (768 ± 728 vs. 110 ± 79, p < 0.01), a shorter mapping time (28 ± 19 min vs. 49 ± 32 min, p < 0.01) and a quicker procedure time (110 ± 33 min vs. 134 ± 50 min, p < 0.01), compared to patients in the Control Group. While there were no significant differences in the acute success (95.6% in the Study Group vs. 90.1% in Control group, p = 0.49), or adverse events (4% in the Study group vs. 7% in the Control group, p = 0.72), patients in the Study group had a higher freedom from ventricular arrhythmia at 1-year (89.7% vs. 70.6%, p = 0.01). The use of the PentaRay catheter was an independent predictor of success (HR = 6.20 [95% CI, 1.08–35.47], p = 0.003).

Conclusions

The use of the PentaRay catheter may improve the outcome of PVC ablation while reducing procedure time.

Graphical abstract

Study flowchart. Patient eligibility criteria, PVC location in each group and main procedural parameters of patients in the Study group and Control group.

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Introduction

Three-dimensional electroanatomic mapping systems have become an essential tool for mapping complex arrhythmias. Moreover, multielectrode catheters with smaller electrodes and closer interelectrode spacing have been shown to be advantageous when mapping atrial or ventricular scars [1,2].

Catheter ablation is an established treatment for premature ventricular contractions (PVC). However, its effectiveness decreases when PVCs arise from outside the right ventricular outflow tract (RVOT) [1,3]. Recently, our research has shown that a combined approach with the PentaRay™ (Biosense Webster, Inc.) mapping catheter and the Pattern Matching Filter (PMF) software (Biosense Webster, Inc.) may increase the level of detail, accuracy, and reliability of the activation map. [4,5] However, this was a single-center study with few patients included.

This multicenter study assessed the acute and 1-year efficacy of the use of multipolar PentaRay™ catheter for the treatment of symptomatic PVCs, compared with a similar strategy where mapping was performed with the ablation catheter. Our hypothesis was that the use of multipolar mapping catheter would translate into more precise activation mapping and consequently higher ablation efficacy.

Section snippets

Study design and setting

Prospective, multicenter, nonrandomized study of consecutive patients with frequent symptomatic PVC referred for catheter ablation from January 2018 to June 2021. In the Study Group, the activation map was obtained using the multipolar PentaRay™ mapping catheter, while in the Control Group mapping was performed with the ablation catheter. The PMF software was used in both groups. The decision to perform PVC mapping with the multipolar or the ablation catheter was left at the discretion of the

Results

Of the initial 140 patients included in this study, 4 were lost during follow-up. (Fig. S-1) The final study sample included 136 patients (60% males, mean age of 55 ± 17 years) – 68 patients in the Study group and 68 patients in the control group. The main baseline characteristics are detailed in Table 1. Patients in the Study group were more often men (75% vs. 44%, p < 0.01) and had ≥2 ectopic foci more frequently (30% vs. 18%, p = 0.04). There were no differences regarding the LVEF, PVC

Discussion

To our knowledge, this is the largest study evaluating the combined use of the PentaRay™ mapping catheter with the PMF software for PVC ablation. Our findings suggest that the use of the PentaRay™ mapping catheter results in higher 1-year freedom from PVC recurrence compared with mapping performed with the ablation catheter.

While the 1-year success rate of RVOT PVC ablation is around 80% [14], ablation of PVCs originating outside the RVOT is more complex, particularly from the papillary muscles

Limitations

We acknowledge some limitations in our work. First, the study was not randomized and thus it is possible that important differences between groups may have been present, although any potential bias was mitigated by the prospective multicenter design of the study, and all procedures were carried out in tertiary high-volume centers by experienced operators. Moreover, the study group included slightly more complex cases, with more patients having been submitted to a previous failed PVC ablation,

Disclosures

P.A.S has received consulting fees from Abbott, Biosense Webster, Boston Scientific and Medtronic. S. B. has received training grants from Biosense Webster and Biotronik. Ms. MP is an employee of Biosense Webster. N.C·D and J.S. received travel and consulting fees from Abbott, Biosense Webster and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Author statement

The data underlying this article will be shared on reasonable request to the corresponding author. No patient or public was involved in the design or execution of the study.

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