Initial Human Feasibility of Infusion Needle Catheter Ablation for Refractory Ventricular Tachycardia

• Published in: Circulation (New York, N.Y.) N.Y.), 2013-11, Vol.128 (21), p.2289-2295
• Main Authors: Sapp, John L, Beeckler, Christopher, Pike, Robert, Parkash, Ratika, Gray, Christopher J, Zeppenfeld, Katja, Kuriachan, Vikas, Stevenson, William G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - adverse effects; Catheter Ablation - instrumentation; Catheter Ablation - methods; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug Resistance; Feasibility Studies; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Needles; Recurrence; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - surgery; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.003423

BACKGROUND—Ablation of ventricular tachycardia (VT) is sometimes unsuccessful when ablation lesions are of insufficient depth to reach arrhythmogenic substrate. We report the initial experience with the use of a catheter with an extendable/retractable irrigated needle at the tip capable of intramyocardial mapping and ablation. METHODS AND RESULTS—Sequential consenting patients with recurrent VT underwent ablation with the use of a needle-tipped catheter. At target sites, the needle was advanced 7 to 9 mm into the myocardium, permitting pacing and recording. Infusion of saline/iodinated contrast mixture excluded perforation and ensured intramyocardial deployment. Further infusion was delivered before and during temperature-controlled radiofrequency energy delivery through the needle. All 8 patients included (6 male; mean age, 54) with a mean left ventricular ejection fraction of 29% were refractory to multiple antiarrhythmic drugs, and 1 to 4 previous catheter ablation attempts (epicardial in 4) had failed. Patients had 1 to 7 (median, 2) VTs present or inducible; 2 were incessant. Some intramyocardial VT mapping was possible in 7 patients. A mean of 22 (limits, 3–48) needle ablation lesions were applied in 8 patients. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs occur at some point during follow-up. Two died of the progression of preexisting heart failure without recurrent VT. Complications included tamponade in 1 patient and heart block in 2 patients. CONCLUSIONS—Intramyocardial infusion-needle catheter ablation is feasible and permits control of some VTs that have been refractory to conventional catheter ablation therapy, warranting further study.