NON-INVASIVE TOPICAL DIAGNOSIS OF VENTRICULAR ARRHYTHMIAS

To compare accuracy of non-invasive topical diagnosis of ventricular arrhythmias using the results of epicardial and combined epi-endocardial mapping and the data of intra-cardiac electrophysiological study, 94 patients (35 men and 59 women) aged 20 67 years (mean age: 43.5 years) with ventricular arrhythmias of different origin and location were examined. In all patients, the non-invasive electrophysiological study was carried out, which included surface ECG in 240 leads, spiral computed tomography with the data processing to locate an area of the earliest activation, corresponding to the arrhythmogenic focus projection. According to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, in 58 patients, the arrhythmogenic focus was located in the right ventricle outflow tract (RVOT): in 3 patients, in the anterolateral area of RVOT; in 8 patients, on the anterior wall of RVOT; in 20 subjects, in the antero-septal area of RVOT; in 23 patients, in the septal area of RVOT; and in 4 subjects, in the postero-septal area of RVOT. The combined epi-endocardial mapping in 56 cases showed the same arrhythmogenic focus location, in 2 patients, discrepancies were revealed. When using epicardial mapping, the arrhythmogenic focus was precisely located in 48 patients. In 8 patients, according to the data of the intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the right ventricle inflow tract (RVIT): in 2 patients, in basal segments of the free wall; in 1 patient, in apical segments of the free wall; in 1 patient, in the antero-septal area on the border between apical and medial segments of the right ventricle; and in 4 patients, in parahisian area, under the tricuspid valve annulus. The epi-endocardial mapping in 6 cases showed the same arrhythmogenic focus location, in 2 patients, discrepancies were revealed. When using epicardial mapping, the arrhythmogenic focus was precisely located in 3 patients. In 12 patients, according to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the left ventricle outflow tract (LVOT): in 3 patients, in the projection of non-coronary aortic sinus; in 2 patients, on the border between of the right and left aortic sinuses; in 2 patients, in the projection of the right aortic sinus; and in 5 patients, in the projection of the left aortic sinus. The epi-endocardial mapping showed the same arrhythmogenic focus location in 11 cases. During epicardial mapping, it was possible to locate the arrthythmogenic focus precisely in 7 patients only. In 16 patients, according to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the left ventricle inflow tract (LVIT): in 2 patients, on the boundary between medial apical segments in the postero-septal position of the left ventricle; in 2 patients, in the apical part of intra-ventricular septum; in 1 patient, in basal parts of the anterior wall; in 1 patient, in basal parts of the lateral wall; in 4 patients, in basal parts of the posterior wall; in 3 patients, in basal parts of LV, in postero-septal location; and in 3 patients, ventricular extrasystoles originated from the left ventricle papillary muscle. The epi-endocardial mapping showed the same arrhythmogenic focus location in 10 cases, epicardial pacing showed the same results. Thus, the topical diagnostics of ventricular arrhythmias based on the epi-endocardial mapping data permits one to locate arrhythmogenic foci with a rather high accuracy.

ventricular arrhythmias, non-invasive electrophysiological study, intra-cardiac electrophysiological study, radiofrequency catheter ablation

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