Risk Assessment and Management of Outflow Tract Arrhythmias Refractory to Prior Treatments

Purpose of Review The ventricular outflow tracts (OT) are a frequent site of origin of idiopathic premature ventricular complexes (PVC) and ventricular tachycardias (VT). Despite relatively high success rates, catheter ablation (CA) may fail to achieve long-term clinical success in some patients. In this article, we briefly review how to approach risk stratification in patients with OT PVC/VT and the methods to improve outcomes in cases that are refractory to standard ablation approaches. Recent Findings Risk stratification should consider the potential for malignant arrhythmic events and the occurrence of arrhythmia-induced cardiomyopathy. When standard ablation fails, advanced ablation techniques can be used to treat OT arrhythmias. Summary Indirect risk stratification methods can be used in patients with refractory OT PVC/VT. Novel ablation therapies, such as alcohol ablation, dispersive patch repositioning or bipolar ablation, can improve OT PVC/VT ablation outcomes.