ABLATION OF VENTRICULAR TACHYARRHYTHMIA ORIGINATING FROM THE RIGHT VENTRICULAR OUTFLOW TRACT IN PATIENTS WITHOUT UNDERLYING HEART DISEASE

To assess effectiveness and safety of ablation of ventricular tachyarrhythmia (VTA) originating from the right ventricular outflow tract, 186 patients aged 37.2±19.4 years were examined and treated. The number of ventricular premature contractions (VPC) detected was 19,454±12,819. Sustained ventricular tachycardia (VT) was documented in 41 patients (22%); implantable cardioverters-defibrillators (ICD) were implanted in 21 patients (11.2%). Freedom of VPC/VT throughout the follow-up period after single or repetitive ablations was the study primary endpoint. The secondary study endpoints were as follows: complications of the procedure, the number of VPC, comparison of the data of patients with the normal and depressed ejection fraction of the left ventricle. The following areas of the VPC/VT location in the right ventricular outflow tract were identified: anterior wall (n=28; 15%), posterior wall (n=26; 14%), septal wall (n=19, 10.2%), free, or lateral, wall (n=22, 11.8%), antero-septal (n=37, 19.9%), postero-septal wall (n=47, 25.3%), antero-lateral (n=2, 1.1%), and postero-lateral (n=5, 2.7%) walls. The effective ablation was performed in 181 subjects (97.3%). The ablative procedure was ineffective in 3 patients (1.6%) with the PVC location in the antero-septal wall and 2 patients (1.1%) with their postero-septal location. In the above patients (n=5, 2.7%), the left ventricular outflow tract mapping was carried out. The PVC/VT location in them was as follows: the left and right Valsalva sinus in 3 patients (1.6%) and 2 patients (1.1%), respectively. Ablation from the side of the left aortic sinus was effective in 1 patient. In other 4 patients, ablative applications were made from the side of both the right ventricular and left ventricular outflow tracts, but without effect. The late effectiveness of the procedure after the single ablation was 88.2%, after repetitive procedures, 95.7%, provided no antiarrhythmic therapy was taken.

ventricular premature contractions, ventricular tachycardia, right ventricular outflow tract, radiofrequency catheter ablation, long-term follow-up, ECG Holter monitoring

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