LATE OUTCOME OF ABLATION OF VENTRICULAR TACHYARRHYTHMIA FROM MITRAL-AORTIC CONTACT AND MITRAL VALVE IN PATIENTS WITHOUT STRUCTURAL HEART DISEASE

To assess effectiveness and safety of ablation of ventricular tachyarrhythmia (VTA) located in the area of the mitral-aortic contact (MAC) and mitral valve (MV) fibrous ring, the data of 132 consecutive patients with VTA originating from the left ventricle (LV) were analyzed. VTA originating from the areas of MAC and MV were revealed in 21 patients (15.9%). Frequent symptomatic ventricular premature contractions (VPC) and/or VT paroxysms were found in all patients, antiarrhythmic therapy (AAT) being ineffective. Patients with structural heart disease were excluded from the study. 18,946±10,948 VPCs per day were documented. The sustained VT was documented in 4 patients (19%). In 20 patients (95.2%), monomorphic VPC/VT was observed. Cardioverters-defibrillators were implanted to 2 patients (9.5%) before the intervention. Antiarrhythmic therapy was ineffective in 21 patients (100%). The following 3 types of the ectopic foci location in patients with VPC/VT were identified: antero-lateral part of MV (n=7; 58%), posterior part of MV (n=2; 16.7%), and postero-septal part of MV (n=3; 14.3%). The total early effectiveness of ablation was 100% (21 patients). No PVC/VT recurrence was revealed in early post-procedure period. Antiarrhythmic therapy was discontinued in all patients with the effective radiofrequency ablation. No post-procedure complications were observed in the study patients. The follow-up period lasted for 38.6±7.4 months. The long-term follow-up data were obtained for 20 patients (95.2%). In one patient from the MAC group (4.8%), the VPC recurrence developed 4.5 months after the primary radiofrequency ablation. The late effectiveness of the ablation of VPC/VT from MAC/MV in absence of AAT was 95.2% (20 patients) after the single ablative procedure and 100% (21 patients) after the repetitive ablation. Thus, despite a relatively low prevalence, VTA originating from the MAC area and the MV fibrous ring, with a number of electrocardiographic features, can be successfully eliminated using radiofrequency ablation, which is a highly effective and safe method of treatment of the arrhythmia.

left ventricle outflow tract, mitral-aortic contact, fibrous ring of mitral valve, ventricular premature contractions, ventricular tachycardia, electrocardiography, radiofrequency catheter ablation

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