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Catheter ablation for fascicular ventricular tachycardia: A systematic review.

Authors :: Creta A
Chow AW
Sporton S
Finlay M
Papageorgiou N
Honarbakhsh S
Dhillon G
Graham A
Patel KHK
Dhinoja M
Earley MJ
Hunter RJ
Lowe M
Rowland E
Segal OR
Calabrese V
Ricciardi D
Lambiase PD
Schilling RJ
Providência R
Source :: International journal of cardiology [Int J Cardiol] 2019 Feb 01; Vol. 276, pp. 136-148. Date of Electronic Publication: 2018 Oct 25.
Publication Year :: 2019
Abstract: Introduction: Catheter ablation has been evaluated as treatment for fascicular ventricular tachycardia (FVT) in several single-centre cohort studies, with variable results regarding efficacy and outcomes.<br />Methods: A systematic search was performed on PubMed, EMBASE and Cochrane database (from inception to November 2017) that included studies on FVT catheter ablation.<br />Results: Thirty-eight observational non-controlled case series comprising 953 patients with FVT undergoing catheter ablation were identified. Three studies were prospective and only 5 were multi-centre. Eight-hundred and eighty-four patients (94.2%) had left posterior FVT, 25 (3.4%) left anterior FVT and 30 (2.4%) other forms. In 331 patients (41%), ablation was performed in sinus rhythm (SR). The mean follow-up period was 41.4 ± 10.7 months. Relapse of FVT occurred in 100 patients (10.7%). Among the 79 patients (8.3%) requiring a further procedure after the index ablation, 19 (2%) had further FVT relapses. Studies in which ablation was performed in FVT had similar success rate after multiple procedures compared to ablation in SR only (95.1%, CI <subscript>95%</subscript> 92.2-97%, I <superscript>2</superscript>  = 0% versus 94.8%, CI <subscript>95%</subscript> 87.6-97.9%, I <superscript>2</superscript>  = 0%, respectively). Success rate was numerically lower in paediatric-only series compared to non-paediatric cases (90.0%, CI <subscript>95%</subscript> 82.1-94.6%, I <superscript>2</superscript>  = 0% versus 94.3%, CI <subscript>95%</subscript> 92.2-95.9%, I <superscript>2</superscript>  = 0%, respectively).<br />Conclusion: Data derived from observational non-controlled case series, with low-methodological quality, suggest that catheter ablation is a safe and effective treatment for FVT, with a 93.5% success rate after multiple procedures. Ablation during FVT represents the first-line and most commonly used approach; however, a strategy of mapping and ablation during SR displayed comparable procedural results to actively mapping patients in FVT and should therefore be considered in selected cases where FVT is not inducible.<br /> (Copyright © 2018 Elsevier B.V. All rights reserved.)