Success predictors of radiofrequency ablation of ventricular premature beats
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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