Percutaneous Coronary Intervention in Frail Patients Undergoing Transcatheter Aortic-Valve Implantation – A NOTION-3 Substudy (JACC Cardiovascular Interventions April 2026-Article: Percutaneous Coronary Intervention in Frail Patients Undergoing Transcatheter Aortic-Valve Implantation

Article: Percutaneous Coronary Intervention in Frail Patients Undergoing Transcatheter Aortic-Valve Implantation – A NOTION-3 Substudy

Back to course

Pdf Summary

This study examined how to improve anatomical radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmias (VAs) arising from the left ventricular summit (LVS), a difficult region to treat because of epicardial fat and nearby coronary arteries. The authors reviewed 40 consecutive patients with successful LVS ablation who also had complete endocardial mapping.<br /><br />The main finding was that ablation was most often successful at the endocardial earliest activation site, not simply at the endocardial site closest to the epicardial earliest activation site in the great cardiac vein (GCV). In 37 of 40 patients (93%), successful ablation occurred at the endocardial earliest activation site or a site immediately adjacent to it. In contrast, targeting the anatomically nearest site to the epicardial signal succeeded in only about half of cases.<br /><br />The study identified two activation patterns. In Type I cases, the endocardial earliest activation matched the successful ablation site and lay near the epicardial earliest site. In Type II cases, the true ablation target was often farther toward the aorta, such as the aorto-mitral continuity, left coronary cusp, or junction of the left and right coronary cusps. These cases showed “eccentric” activation, meaning the epicardial and endocardial activation sites did not align simply by distance.<br /><br />The authors conclude that for LVS arrhythmias, operators should first target the endocardial earliest activation site during anatomical ablation rather than the site closest to the epicardial earliest activation in the GCV. This approach may improve success and avoid unnecessary ablation.

Meta Tag

Concept Left Ventricular Summit Ventricular Arrhythmia

Concept Endocardial Earliest Activation Site

Concept Epicardial Mapping

Concept Activation Mapping

Concept Radiofrequency Catheter Ablation

Keywords

left ventricular summit

ventricular arrhythmias

radiofrequency catheter ablation

endocardial earliest activation

epicardial earliest activation

great cardiac vein

aorto-mitral continuity

left coronary cusp

coronary cusp junction

anatomical ablation

Left Ventricular Summit Ventricular Arrhythmia

Endocardial Earliest Activation Site

Epicardial Mapping

Activation Mapping

Radiofrequency Catheter Ablation