Radiofrequency ablation can reverse the structural remodeling caused by frequent premature ventricular contractions originating from the right ventricular outflow tract even in a normal heart

OBJECTIVE: The aim of this study was to evaluate whether frequent premature ventricular contractions originating from the right ventricular outflow tract remodel the cardiac structure and function in patients with a “seemingly normal heart” and whether radiofrequency ablation can reverse this remodeling. METHODS: Sixty-eight patients with idiopathic frequent premature ventricular contractions originating from the right ventricular outflow tract and normal heart structure and function were enrolled in this study. The patients were divided into three groups according to the therapeutic method: radiofrequency ablation group (24 cases), anti-arrhythmia drug group (26 cases), and control group (18 cases without any treatment). Clinical Registration number: ChiCTR-ONRC-12002834 RESULTS: The basic patient characteristics were comparable between the three groups, except for the premature ventricular contraction rate, which was significantly lower in the control group. After six months of follow up, the premature ventricular contraction rate was significantly reduced in the radiofrequency ablation group, which was accompanied by a significant decrease in the following cardiac cavity inner diameters, as determined by echocardiography: right atrium (33.33±3.78 vs. 30.05±2.60 mm, p = 0.001), right ventricle (23.24±2.40 vs. 21.05±2.16 mm, p = 0.020), and left ventricle (44.76±4.33 vs. 41.71±3.44 mm, p = 0.025). These results were similar in the anti-arrhythmia drug group, although this group exhibited a smaller extent of change (right atrium: 33.94±3.25 vs. 31.27±3.11 mm, p = 0.024; right ventricle: 22.97±3.09 vs. 21.64±2.33 mm, p = 0.049; left ventricle: 45.92±6.38 vs. 43.84±5.67 mm, p = 0.039), but not in the control group (p>0.05). There was a tendency toward improvement in the cardiac functions in both the radiofrequency ablation and anti-arrhythmia drug groups. However, ...

Ablação com radiofreqüência de extra-sístoles da via de saída do ventrículo direito / Radiofrequency catheter ablation of premature ventricular contractions originating in the right ventricular outflow tract

OBJETIVOS: Avaliar se a ablação com radiofreqüência é um procedimento eficiente para o tratamento das extra-sístoles da via de saída do ventrículo direito (EVSVD), e se resulta em melhora dos sintomas. MÉTODOS: Estudo prospectivo, com 30 pacientes consecutivos (idade média de 40±13 anos, 25 do sexo feminino), sem cardiopatia estrutural aparente, com EVSVD, muito freqüentes (densidade média de 1.263±593/h), sintomáticos por mais de 1 ano (média =74 meses) e refratários aos fármacos antiarrítmicos (3±1,7, incluindo os beta-bloqueadores), que foram submetidos à ablação com radiofreqüência. RESULTADOS: Após o primeiro procedimento, houve 23 sucessos iniciais (76,6 por cento) e 7 iniciais insucessos (23,4 por cento). Quatro pacientes tiveram recorrências, sendo que dois desses não se submeteram ao segundo procedimento. O segundo procedimento foi realizado em 9 pacientes (7 insucessos iniciais e 2 recorrências), e o sucesso ocorreu em 5 pacientes adicionais, sendo 1 caso por acesso epicárdico. A taxa de sucesso final foi de 80 por cento (24/30), e nenhuma complicação maior ocorreu. Após um seguimento médio de 14±6 meses, no grupo de sucesso final houve uma redução de mais de 90 por cento na densidade das extra-sístoles(24/24; p<0,0001) e resultante ausência de sintomas na maioria dos pacientes (23/24; p<0,001). CONCLUSÃO: A ablação com radiofreqüência é um tratamento seguro e eficaz para os pacientes com extra-sístoles persistentes e sintomáticas com morfologia do trato de saída do ventrículo direito.

OBJECTIVES: To evaluate if radiofrequency catheter ablation is an effective procedure for the treatment of right ventricular outflow tract premature ventricular contractions (RVOT-PVC) and ascertain if it results in an improvement of symptoms. METHODS: A prospective study with 30 consecutive patients (mean age 40 ± 13 years, 25 females), with no apparent structural cardiopathy, with very frequent (mean density of 1,263 ± 593/h) RVOT-PVC, symptomatic for more than one year (mean = 74 months) and resistant to antiarrhythmic drugs (3 ± 1.7, including beta-blockers), who underwent radiofrequency catheter ablation. RESULTS: After the first procedure, there were 23 initial successful cases (76.6 percent) and 7 initial failures (23.4 percent). Four patients experienced relapses, two of whom did not undergo the second procedure. The second procedure was carried out in 9 patients (7 initial failures and 2 relapses), and there was success in 5 additional patients, one of them by epicardial access. The final success rate was 80 percent (24/30), and there were no major complications. After a mean follow-up of 14 ± 6 months, in the successful group there was a reduction greater than 90 percent in density of premature ventricular contractions (PVC) (24/24; p<0.0001) and a resulting absence of symptoms in the majority of patients (23/24; p<0.001). CONCLUSION: Radiofrequency catheter ablation is a safe and effective treatment for patients with persistent and symptomatic PVC with RVOT morphology.

Ablación por radiofrecuencia de extrasistolía ventricular aislada sintomática en corazón sano / Radiofrequency catheter ablation in symptomatic premature ventricular depolarizations in patients without heart disease

Introduction: Premature ventricular depolarizations (PVDs) in patients without heart disease, are a frequent clinical problem that can cause important symptoms. Most commonly, this benign arrhythmia responds to treatment with antiarrhythmic drugs. However, occasionally PVDs are refractory to pharmacological treatment but they can be eliminated with radiofrecuency catheter ablation. Aim: To show our experience with four patients in whom we used this method. Material and method: We studied three men and a woman, twelve to forty six years old. All of them were symptomatic, their EKG and echocardiogram were normal and they had been treated with several drugs without response. In three of them the PVDs had left bundle-branch block morphology with inferior axis; the other patient had right bundle-branch block morphology with superior axis. The origin of the PVDs was determined using pace mapping. Results: Two of the patients had spontaneous PVDs; in the other two isoproterenol infusion was used to induce them. In three patients the origin of the PVDs was located in right ventricular outflow and in the other in the anterolateral region of the left ventricle. None had sustained atrial or ventricular arrhythmia. In all of them PVDs were eliminated. A patient presented a second morphology that could not be treated. None of the patients had complications and they were discharged within the next 24 hours. Three noted symptomatic improvement and after 18 months, only one had a probable recurrence of the arrhythmia. Conclusions: radiofrecuency catheter ablation can be successfully used to eliminate PVDs in severely symptomatic and drug-resistant patients

Ablación por radiofrecuencia de extrasistolía ventricular frecuente sintomática / Radiofrequency ablation of symptomatic frequent ventricular extrasistolia

La actividad ectópica ventricular es una arritmia de habitual observación, que puede estar asociada o no a enfermedad cardíaca evidente. En este trabajo describimos una paciente con actividad ectópica ventricular muy frecuente y sintomática, incluso incapacitante, sin cardiopatía estructural, refractaria al tratamiento antiarrítmico. Dada estas características se decidió realizar un procedimiento de ablación por radiofrecuencia para eliminar la arritmia y en consecuencia con sus síntomas