Catheter ablation for fascicular ventricular tachycardia: A systematic review

Introduction: Catheter ablation has been evaluated as treatment for fascicular ventricular tachycardia (FVT) in several single-centre cohort studies, with variable results regarding efficacy and outcomes.

Methods: A systematic search was performed on PubMed, EMBASE and Cochrane database (from inception to November 2017) that included studies on FVT catheter ablation.

Results: Thirty-eight observational non-controlled case series comprising 953 patients with FVT undergoing catheter ablation were identified. Three studies were prospective and only 5 were multi-centre. Eight-hundred and eighty-four patients (94.2%) had left posterior FVT, 25 (3.4%) left anterior FVT and 30 (2.4%) other forms. In 331 patients (41%), ablation was performed in sinus rhythm (SR). The mean follow-up period was 41.4 ± 10.7 months. Relapse of FVT occurred in 100 patients (10.7%). Among the 79 patients (8.3%) requiring a further procedure after the index ablation, 19 (2%) had further FVT relapses. Studies in which ablation was performed in FVT had similar success rate after multiple procedures compared to ablation in SR only (95.1%, CI_95% 92.2-97%, I² = 0% versus 94.8%, CI_95% 87.6-97.9%, I² = 0%, respectively). Success rate was numerically lower in paediatric-only series compared to non-paediatric cases (90.0%, CI_95% 82.1-94.6%, I² = 0% versus 94.3%, CI_95% 92.2-95.9%, I² = 0%, respectively).

Conclusion: Data derived from observational non-controlled case series, with low-methodological quality, suggest that catheter ablation is a safe and effective treatment for FVT, with a 93.5% success rate after multiple procedures. Ablation during FVT represents the first-line and most commonly used approach; however, a strategy of mapping and ablation during SR displayed comparable procedural results to actively mapping patients in FVT and should therefore be considered in selected cases where FVT is not inducible.