LAUSR

INTRODUCTION Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originate from the aortic cusps can be challenging. Long-term efficacy and safety data as well as optimal technique after aortic cusp ablation have not previously been reported. OBJECTIVES This aim of the study was to determine the short- and long-term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. PATIENTS AND METHODS This was a prospective multicenter registry (AVATAR) study. One hundred and three patients at the mean age of 56.0 years [34.0-64.0] from the "Electra" Registry (2005-2017) undergoing RFA of aortic cusps VA were enrolled. Three ablation techniques were used: zero-fluoroscopy- ZF (electroanatomical mapping- EAM without fluoroscopy), EAM with fluoroscopy and conventional fluoroscopy-based RFA. Clinical history, complications after RFA, echocardiography, and 24-hour Holter monitoring data were collected. The follow-up was ≥ 12 months. RESULTS There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median procedure time was 75.0 min [58.0-95.0], median follow-up- 32 months [12.0-70.0]. Acute and long-term procedural success rates were 93% and 86%, respectively. The long- term RFA outcomes were highest with ZF technique-88%, in EAM with fluoroscopy-86% and conventional RFA- 82%, however without significant differences. During long-term follow-up, no significant abnormalities were found within the aortic root. CONCLUSIONS Ablation of VA within the aortic cusps is safe and effective in long-term follow-up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities.