Preview

Journal of Arrhythmology

Advanced search

ASSESSMENT OF EFFECTIVENESS OF ABLATION OF VENTRICULAR TACHYARRHYTHMIA ORIGINATING FROM THE RIGHT VENTRICULAR INFLOW TRACT IN PATIENTS WITHOUT UNDERLYING HEART DISEASE

Abstract

To assess effectiveness and safety of radiofrequency ablation (RFA) of ventricular tachyarrhythmia (VTA) located in the right ventricular inflow tract, 32 patients aged 39.7±19.1 years were examined and treated. The number of ventricular premature contractions (PVC) detected was 17,642±13,475; sustained ventricular tachycardia (VT) was documented in 7 patients (21.9%); implantable cardioverters-defibrillators (ICD) were implanted in 4 patients (12.5%). Antiarrhythmic therapy was ineffective in all patients. RFA was performed using the NaviStar ThermoCool irrigated electrode, with the irrigation velocity of 17 ml/min, maximal power or 40 W, maximal temperature of 43°C, and the duration of each application of 40 60 s. 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 and the number of VPC. In 20 patients (62.5%), VTA originated from the tricuspid valve area and, in 12 patients (37.5%), from the basal part of the right ventricle. In 29 patients (90.6%), the only morphology of PVC/VT was revealed; 3 patients (9.4%) had polymorphous PVCs. The number of points for 3D reconstruction of the right ventricular inflow tract endocardial surface was 37±11. The normal endocardial voltage in the right ventricular inflow tract was revealed in all patients. The number of radiofrequency applications was 10.6±3.2, with the fluoroscopy exposure of 6.6±2.8 min and the procedure duration of 59.7±10.2 min. In 2 patients (6.2%), RFA was not performed because of parahisian location of PVs and a high risk of development of complete atrio-ventricular block. In one patient (3.1%) with the PVC/VT location in the free wall, the RFA in the right ventricle was ineffective. Thus, the overall effectiveness of RFA was 93.8% (30 patients). The late effectiveness of the procedure after the single ablation was 87.5%, after repetitive procedures, 93.8%. Thus, RFA of VTA originating from the right ventricular inflow tract is a highly effective and safe technique of treatment which permits one to maintain the sinus rhythm during the entire follow-up period.

About the Authors

E. A. Ivanitsky
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗРФ, Красноярск
Russian Federation


VA. .. Sakovich
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗРФ, Красноярск
Russian Federation


E. B. Kropotkin
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗРФ, Красноярск
Russian Federation


D. B. Drobot
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗРФ, Красноярск
Russian Federation


S. N. Artemenko
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


V. V. Shabanov
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


R. T. Kamiev
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


A. G. Strelnikov
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


I. G. Stenin
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


D. V. Elesin
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


A. B. Romanov
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


E. A. Pokushalov
ФГБУ «Новосибирский НИИ патологии кровообращения имени Е.Н.Мешалкина» МЗРФ
Russian Federation


References

1. Satish OS, Yeh KH, Wen MS, et al. Focal right ventricular tachycardia originating from the subtricuspid septum // Europace 2005; 7: 348.

2. Tada H, Tadokoro K, Ito S, et al. Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation // Heart Rhythm 2007; 4: 7.

3. Zhu DW, Maloney JD, Simmons TW, et al. Radiofrequency catheter ablation for management of symptomatic ventricular ectopic activity // J Am Coll Cardiol 1995; 26: 843-9.

4. Seidl K, Schumacher B, Hauer B et al. Radiofrequency catheter ablation of frequent monomorphic ventricular ectopic activity // J Cardiovasc Electrophysiol 1999; 10: 924-34.

5. Ventura R., Steven D., Klemm H., et al. Decennial follow-up in patients with recurrent tachycardia originating from the right ventricular outflow tract: electrophysiologic characteristics and response to treatment // European Heart Journal (2007) 28, 2338-2345

6. Takemoto M., Yoshimura H.,Ohba Y., et al. Radiofrequency Catheter Ablation of Premature Ventricular Complexes From Right Ventricular Outflow Tract Improves Left Ventricular Dilation and Clinical Status in Patients Without Structural Heart Disease // J Am Coll Cardiol 2005; 45: 1259-65.

7. Aliot EM., Stevenson W., Calkins H., et al. EHRA/ HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) // Heart Rhythm, 2009; 6 (6): 886-933.

8. Ceresnak S., Pass R., Krumerrman A., et al. Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle // Journal of Electrocardiology, 2012, 45 (4), 385-390.

9. Tada, H., Tadokoro, K., Ito, S., et al. Idiopathic ventricular arrhythmias originating from the tricuspid annulus: Prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation // Heart rhythm 2007, 4(1), 7-16.

10. Колунин Г.В., Кузнецов В.А., Харац В.Е. и другие. Применение криоаблации в лечении желудочковых нарушений ритма сердца // Вестник аритмологии 2013; № 72: 62-68.


Review

For citations:


Ivanitsky E.A., Sakovich V..., Kropotkin E.B., Drobot D.B., Artemenko S.N., Shabanov V.V., Kamiev R.T., Strelnikov A.G., Stenin I.G., Elesin D.V., Romanov A.B., Pokushalov E.A. ASSESSMENT OF EFFECTIVENESS OF ABLATION OF VENTRICULAR TACHYARRHYTHMIA ORIGINATING FROM THE RIGHT VENTRICULAR INFLOW TRACT IN PATIENTS WITHOUT UNDERLYING HEART DISEASE. Journal of Arrhythmology. 2013;(74):45-49. (In Russ.)

Views: 136


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1561-8641 (Print)
ISSN 2658-7327 (Online)