Success predictors of radiofrequency ablation of ventricular premature beats
Abstract
Objective – to determine the optimal parameters of stimulation and activation mapping during radiofrequency ablation (RFA) of ventricular premature beats (VPB).
Materials and methods. We have analyzed 134 consecutive cases of patients with RFA of monomorphic VPB. The mean age of patients was (37.2 ± 12.1) years. 87 (64.9 %) of patients were female. All patients with VPB were treated by the RFA according to standard procedure protocol. As part of this technique following application parameters of successful application area of interest were analyzed: outrunning of local endogram, compared with surface ECG and percent of matching of stimulated QRS-complex with VPB using function «match». The criterion for the efficiency of procedure was assumed number of VPB < 1 % of the daily rhythm.
Results. Localization of held ablation were: right ventricular outflow tract in 86 (64.2 %) patients, sinuses of Valsalva – in 17 (12.7 %), left ventricular outflow tract – in 9 (6.7 %), interventricular septum – in 7 (5.2 %), ventral apical segments – in 6 (4.5 %), tricuspid valve ring – in 5 (3.7 %), parahisian area – in 2 (1.5 %), the ostium of the left coronary artery – in 2 (1.5 %). An qualitative stimulation maps (match – (93.3 ± 4.9) %) and activation maps ((27.2 ± 10.4) ms) were obtained. All patients had a statistical significant reduction in the number of VPB from 24 803 ± 6 453.29 per day before ablation to 648.73 ± 393.73 per day in 48 hours and to 738.52 ± 283.37 per day in 6 months after ablation, i.e. by 97 % (p < 0.01). Percentage of VPB in the daily rhythm decreased from 24.32 ± 11.23 before ablation to 0.5 ± 0.24 in 48 hours after ablation and to 0.57 ± 0.29 in 6 months (p < 0.05). Cumulative effectiveness of the procedures was 86.5 % during the follow-up after 6 months.
Conclusions. RFA is effective method of treatment, which can reduce the percentage of VPB in the daily rhythm by 97 % (p < 0.01). RF applications success-predictor is a combination of: outrunning > 30 ms during activation mapping and «match» > 95 % during stimulation mapping (p < 0.001). RFA is safe procedure. The risk of non-fatal complications was 1.5 % (p < 0.05).
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References
Stec S, Sikorska A, Zaborska B, Krynski T, Szymot J, Kulakowski P. Benign symptomatic premature ventricular complexes: short- and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation. Kardiol. Pol. 2012;70(4):351-8.
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. Eur. Heart J. 2007;28(19):2338-45.
Wen MS, Taniguchi Y, Yeh SJ, Wang CC, Lin FC, Wu D. Determinants of tachycardia recurrences after radiofrequency ablation of idiopathic ventricular tachycardia. Am. J. Cardiol. 1998;81(4):500-3.
Dixit S, Marchlinski FE. Clinical characteristics and catheter ablation of left ventricular outflow tract tachycardia. Curr. Cardiol. Rep. 2001;3(4):305-13.
Ge B, Ji KT, Ye HG et al. Electrocardiogram features of premature ventricular contractions/ventric- ular tachycardia originating from the left ventricular outflow tract and the treatment outcome of radiofrequency catheter ablation. BMC Cardiovasc Disord. 2012;12:112-4. doi: 10.1186/1471-2261-12-112.
Movsowitz C, Schwartzman D, Callans CD et al. Idiopathic right ventricular outflow tract tachycardia: narrowing the anatomic location for successful ablation. Am. Heart J. 1996;131:930-6.
Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckinqham TA, Goldberg RJ. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N. Engl. J. Med. 1985;312:193-7.
Gaita F, Giustetto C, Di Donna P et al. Long-term follow-up of right ventricular monomorphic extrasystoles. Am. Coll. Cardiol. 2001;38:364-70.
Messineo FC. Ventricular ectopic activity: prevalence and risk. Am. J. Cardiol.1989;64(20):53-6.
Kostis JB, McCrone K, Moreyra AE et al. Premature ventricular complexes in the absence of identifiable heart disease. Circulation. 1981;63:1351-6.
Greil GF, Gass M, Kuehlkamp V et al. Radiofrequency ablation of right ventricular outflow tract tachycardia using a magnetic resonance 3D model for interactive catheter guidance. Clin. Res. Cardiol. 2006;95:610-3. doi:10.1007/s00392-006-0431-6
Seidl K, Schumacher B, Hauer B et al. Radiofrequency catheter ablation of frequent monomorphic ventricular ectopic activity. J. Cardiovasc. Electrophysiol. 1999;10:924-34.
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.
Sheldon SH, Gard JJ, Asirvatham SJ. Premature ventricular contractions and non-sustained ventricular tachycardia: association with sudden cardiac death, risk stratification, and management strategies. Ind Pacing Electrophysiol J. 2010;10:357-71.
Azegami K, Wilber DJ, Arruda M, Lin AC, Denman RA. Spatial resolution of pacemapping and activation mapping in patients with idiopathic right ventricular outflow tract tachycardia. J. Cardiovasc. Electrophysiol. 2005;16:823-9.
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