Neal K Bhatia, Rim N Halaby, Christopher G Bruce, Anand D Shah, Nitish Badhwar, Adam B Greenbaum, Vasilis C Babaliaros, Robert J Lederman
{"title":"Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Initial Human Experience.","authors":"Neal K Bhatia, Rim N Halaby, Christopher G Bruce, Anand D Shah, Nitish Badhwar, Adam B Greenbaum, Vasilis C Babaliaros, Robert J Lederman","doi":"10.1016/j.jacep.2025.06.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation for ventricular arrhythmias is limited by a high first-attempt failure rate approaching 50% to 60%. Failure appears driven by physical inaccessibility of mapping and ablating deep intramyocardial substrate. Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE) is a novel procedure to steer guidewires within the walls of the beating left ventricle (LV) from a right ventricular entry point and deliver a deep intramural ablation electrode anywhere within the LV.</p><p><strong>Objectives: </strong>The objective of this work is to assess the provisional safety and efficacy of VINTAGE intramyocardial navigation and ablation as first offered to patients.</p><p><strong>Methods: </strong>This is a retrospective review of all patients who underwent VINTAGE at Emory University in the practice of medicine for recurrent ventricular tachycardia (VT) or a high burden of premature ventricular contractions (PVC) despite prior ablation and antiarrhythmic drugs.</p><p><strong>Results: </strong>Thirteen patients (39% female) with a median of 2 (IQR: 1-3) prior ablations underwent VINTAGE (1 repeat, total 14 procedures), of whom 5 (39%) had VT and 8 (62%) had PVCs. Arrhythmias originated in the LV summit (n = 3), basal-lateral wall (n = 4), septum (n = 3), inferior wall (n = 1), and papillary muscles (n = 2). Technical success was 100%. At median follow-up of 150 days, clinical success by patient (reduction in VT therapy of PVC burden >80%) was 85% (100% for VT and 75% for PVC). Four of 5 (80%) of the VT cohort were free from appropriate implantable cardiac defibrillator shocks, appropriate antitachycardia pacing, or hospital admission due to recurrent VT. One suffered a nondisabling stroke and another a vascular complication.</p><p><strong>Conclusions: </strong>VINTAGE was effective at creating intramural ablation lesions and treating ventricular arrhythmias arising from targets traditionally considered inaccessible from the endocardium and epicardium, including infarcted myocardium.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Clinical electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacep.2025.06.003","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Catheter ablation for ventricular arrhythmias is limited by a high first-attempt failure rate approaching 50% to 60%. Failure appears driven by physical inaccessibility of mapping and ablating deep intramyocardial substrate. Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE) is a novel procedure to steer guidewires within the walls of the beating left ventricle (LV) from a right ventricular entry point and deliver a deep intramural ablation electrode anywhere within the LV.
Objectives: The objective of this work is to assess the provisional safety and efficacy of VINTAGE intramyocardial navigation and ablation as first offered to patients.
Methods: This is a retrospective review of all patients who underwent VINTAGE at Emory University in the practice of medicine for recurrent ventricular tachycardia (VT) or a high burden of premature ventricular contractions (PVC) despite prior ablation and antiarrhythmic drugs.
Results: Thirteen patients (39% female) with a median of 2 (IQR: 1-3) prior ablations underwent VINTAGE (1 repeat, total 14 procedures), of whom 5 (39%) had VT and 8 (62%) had PVCs. Arrhythmias originated in the LV summit (n = 3), basal-lateral wall (n = 4), septum (n = 3), inferior wall (n = 1), and papillary muscles (n = 2). Technical success was 100%. At median follow-up of 150 days, clinical success by patient (reduction in VT therapy of PVC burden >80%) was 85% (100% for VT and 75% for PVC). Four of 5 (80%) of the VT cohort were free from appropriate implantable cardiac defibrillator shocks, appropriate antitachycardia pacing, or hospital admission due to recurrent VT. One suffered a nondisabling stroke and another a vascular complication.
Conclusions: VINTAGE was effective at creating intramural ablation lesions and treating ventricular arrhythmias arising from targets traditionally considered inaccessible from the endocardium and epicardium, including infarcted myocardium.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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