LATE ASSESSMENT OF EFFECTIVENESS AND SAFETY OF CATHETER RADIOFREQUENCY ABLATION OF VENTRICULAR TACHYARRHYTHMIA FROM AORTIC SINUS

To assess effectiveness and safety of ablation of ventricular tachyarrhythmia located in the aortic sinus area, the data of 79 consecutive patients (including 46 women) aged 40.6±21.8 years with frequent symptomatic ventricular premature contractions (VPC) or ventricular tachycardia (VT) were analyzed. Arterial hypertension was documented in 9 patients (11.4%); diabetes mellitus, in 2 subjects (2.5%). The daily incidence of VPCs was 20,789±12,432. Sustained VT was documented in 17 patients (21.5%). Cardioverters-defibrillators were implanted to 11 patients (13.9%) due to hemodynamically significant VT with syncope. Antiarrhythmic therapy was ineffective in 79 patients (100%). According to the data of stimulation mapping, a significant correlation of the QRS complex morphology with the initial morphology of PVC or VT in 12 surface leads was found in 69 patients (87.3%), in 11 leads was documented in 9 patients (11.4%), and in 10 leads, in 1 patient (1.3%). The number of radiofrequency applications was 3.2±1.5. The duration of fluoroscopy and of the procedure was 7.6±4.2 min and 59.5±12.6 min, respectively. The early total effectiveness of ablation was 97.5% (77 subjects). The patients were followed for 46.6±9.4 months. Two patients (2.5%) were lost for follow-up 30 months after the procedure. The total effectiveness of the procedure after one procedure (without antiarrhythmic treatment) was 93.7% (74 patients), after repetitive procedures, 96.2% (76 patients). Thus, the radiofrequency catheter ablation of ventricular tachycardia originating from aortic sinus is a safe and effective technique of treatment confirmed during the long-term follow-up.

ventricular premature contractions, ventricular tachycardia, left ventricle, aortic sinuses, coronary arteries, radiofrequency catheter ablation

1. Iwai S., Cantillon D., Kim R., et al. Right and Left Ventricular Outflow Tract Tachycardias: Evidence for a Common Electrophysiologic Mechanism // J Cardiovasc Electrophysiol; 17: 1052-1058.

2. Aliot E.M., 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.

3. Kanagaratnam L., Tomassoni G., Schweikert R., et al. Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia // J Am Coll Cardiol 2001; 37: 1408 -1414.

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. Мамчур С.Е., Оферкин А.И., Петш А.И. и другие. Отдаленные результаты радиочастотной аблации желудочковых аритмий у пациентов без структурной патологии сердца // Вестник Аритмологии 2010; № 61: 11-16.

7. Мамчур С.Е., Хоменко Е.А., Чистюхин О.М. и другие. Быстрое картирование эктопических очагов в выводном отделе правого желудочка при помощи катетера «Lasso» // Вестник Аритмологии 2011; № 66: 19-22.

8. Yakemoto 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.

9. Ouyang F., Fotuhi P., Ho S.Y., at al. Repetitive Monomorphic Ventricular Tachycardia Originating From the Aortic Sinus Cusp // J Am Coll Cardiol 2002; 39: 500-8.

10. Stevenson W.G., Soejima K. Catheter ablation for ventricular tachycardia // Circulation 2007; 115: 2750-2760.

11. Friedman P.L., Stevenson W.G., Bittl J.A., et al. Left main coronary artery occlusion during radiofrequency catheter ablation of idiopathic outflow tract ventricular tachycardia // Pacing Clin Electrophysiol 1997; 20: 1185 (abstract).

12. Yamada Т., Murakami Y., Yoshida N., et al. Preferential Conduction Across the Ventricular Outflow Septum in Ventricular Arrhythmias Originating From the Aortic Sinus Cusp // J Am Coll Cardiol 2007; 50: 884-91.

13. Rillig A., Meyerfeldt U., Birkemeyer R., et al. Catheter ablation within the sinus of Valsalva - A safe and effective approach for treatment of atrial and ventricular tachycardias // Heart Rhythm 2008; 5: 1265-127.

14. Anderson R.H. Clinical anatomy of the aortic root // Heart 2000;84: 670-3.

15. Takahashi N., Saikawa T., Oribe A., et al. Radiofrequency catheter ablation from the left sinus of Valsalva in a patient with idiopathic ventricular tachycardia // Pacing Clin Electrophysiol 2000; 23: 1172-1175.

16. Pons M., Beck L., Leclercq F., et al. Chronic left main coronary artery occlusion:a complication of radiofrequency ablation of idiopathic left ventricular tachycardia // Pacing Clin Electrophysiol 1997; 20: 1874-1876.

17. Yamada T., McElderry T., Doppalapudi H., et al. Idiopathic Ventricular Arrhythmias Originating From the Aortic Root Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Results of Radiofrequency Catheter Ablation // J Am Coll Cardiol 2008; 52: 139-47.

18. McAlpine W.A. Heart and Coronary Arteries. New York, NY: Springer-Verlag, 1975.