Utility of a novel non-steerable 3 French decapolar catheter for mapping of distal coronary sinus during ablation of premature ventricular contractions originating from the left ventricular summit

Background/Introduction

Ablation of the arrhythmia substrate originating from the left ventricular summit (LVS) and adjacent locations often requires mapping of the cardiac venous system(CVS) , which is not always possible using standard ablation or diagnostic electrodes due to the small size of these vessels.

In these cases, smaller-diameter electrodes (2-3 F) play a particularly important role. However, their availability in some European countries/ regions is limited.

Purpose

Our aim was to determine the feasibility and safety of a novel 3 French non-steerable decapolar catheter dedicated for mapping of coronary venous system (3F CS catheter) during radiofrequency (RF) ablation of premature ventricular contractions originating from the LVS/LVIT area. /and adjacent locations

Methods

We included consecutive PVC ablation cases performed between 2023 and 2025 using the 3F CS catheter. The catheter was carefully introduced to the CS via a long 8,5 F sheath and gently advanced to the level of the great cardiac vein (GCV) or anterior interventricular vein (AIV). Arrhythmias were mapped and ablated using a 3,5 mm open-irrigated catheter with contact force and a 3D-mapping system. Clinical, procedural, and follow-up data (minimum 3 months after the procedure) were extracted from medical records of our centre.

Results

A total of 14 patients (42% female; mean age 67,8 ± 12 years old, one redo procedure) underwent CVS mapping using the 3F catheter. The level of GCV/AIV was achieved for mapping in 13 out of 14 cases. In one case , the small diameter of the vessel and a prominent valve visible on angiography prevented the catheter from reaching GCV. Endocardial ablation was performed in 9 (64 %) of cases, CS-only ablation in one case, and endo/epicardial ablation in another 4 (28 %). The acute success rate defined as total elimination of PVC was achieved in 9 (64%) of cases, partial success defined as suppression od PVC was achieved in 4(28%). Two significant complications occurred: one tamponade during RF application in distal CVS and one pseudoaneurysm requiring surgical intervention. A follow-up data was available for 8 (57%) patients. The PVC count ranged between 100 and 10000/day with one evident case of ablation failure with 35 000 PVC/day.

Conclusions

The novel 3F catheter is a helpful tool for mapping the cardiac venous system during ablation of PVC from the LVS and adjacent locations. No complications related to this catheter have been observed. However, larger multicentre studies are needed to confirm these findings.RAOLAO