Reviewing Strategies and Our Approach to Mapping and Ablation of Left Ventricular Summit Arrythmias

Background: Left ventricular (LV) summit is important origin for ventricular arrhythmias (VAs). However, the complex electroanatomic structure of LV summit and the surrounding anatomic sites, makes ablation of this arrythmia challenging. Aim: In this paper, we review the main strategies to mapping and ablation of LV summit VAs and summarize our experience in this challenging ablation. Methods: to summarize our experience, we included All consecutive patients with outflow VAs referred to ablation in our institute between 2019 and 2024 who eventually diagnosed to have LV summit origin based on electroanatomical mapping and ablation result using stepwise and sequential ablation approach Results: A total of 38 patients were found to have VAs from LV summit origin. Overall 5 patients had history of at least 1 failed ablation. V1 transition was seen in 15 patients, V2 transition in 12 patients, V3 transition in 11 patients. Four patients had R wave pattern break in lead V2. Ablation was performed from the earliest activation and or from one of the adjacent sites using stepwise and sequential approach. Acute suppression of VAs occurred in 35 patients without complications except one case of pseudoaneurysm of femoral artery. Conclusion: stepwise and sequential ablation approach can suppress VAs originated from LV summit in most of patients.