RESUMO
Background: Premature ventricular beats [PVBs] are early depolarization of the myocardium originating in the ventricle, the prognosis in patients with frequent PVBs and no obvious organic heart disease is usually very good. However, many patients are severely symptomatic with impaired quality of life
Aim of the study: We aimed at our study to assess the success of radiofrequency catheter ablation of monomorphic PVB and its impact on improvement of left ventricular [LV] systolic functions
Patients and Methods: The current study was conducted on 40 patients with frequent symptomatic monomorphic PVBs, candidate for PVB radiofrequency catheter ablation in cardiology department, Ain Shams University, between 2013 and 2015. All patients were subjected to thorough history taking, complete general and local examination, conventional 2D echocardiography and pre-procedural Holter ECG monitoring. Patients were divided to two groups [20 patients in each group] according to the presence or absence of structural heart disease. Electrophysiological mapping and ablation was done for all patients, and their clinical, electrophysiological and procedural aspects were analyzed. Follow up echocardiography and Holter ECG monitoring was done 3-6 months later to assess recurrence and impact on LV internal dimensions and systolic functions
Results: Acute success was achieved in 35 patients [87.5%], and long term success was achieved in 30 patients [75%], with elimination of PVBs and distressing symptoms among group of patients with procedural success. Presence of structural heart disease was not related statistically to procedural failure or long term recurrence. Magnitude of reduction of PVB burden had significant correlation with improvement of systolic functions [P=0.04]. Significant improvement of echocardiographic parameters was witnessed among group with baseline LV systolic dysfunction
Conclusions: Radiofrequency catheter ablation is an effective and safe therapeutic tool for frequent monomorphic PVBs and should be addressed as 1[st] line option for reversal of PVB induced LV systolic dysfunction
Assuntos
Adulto , Feminino , Humanos , Masculino , Ablação por Cateter , Recidiva , Eletrofisiologia , Ventrículos do Coração/fisiopatologia , Volume Sistólico , SístoleRESUMO
Background: Cardiac resynchronization therapy [CRT] is now an established effective treatment for patients with advanced heart failure. One approach to improve CRT outcome may be determination of the degree of dsynchrony before CRT as a predictor for CRT response. Conversely, the focus may be on an improved positioning of CRT left ventricular [LV] lead
Aim of the study: We aimed at our study to define the rule of three-dimensional echocardiography in determining the optimal site of LV pacing lead
Patients and Methods: The current study was conducted on 30 patients with heart failure who had received CRT in Ain Shams University Hospitals in the period from 2012 to 2014. All patients were subjected to thorough history taking, complete general and local examination, conventional 2D echo and 3D echo analysis. The latest wall to reach the minimal volume was determined. The patients were classified after CRT insertion into group A with concordance between the delayed LV area and LV lead position and group B with discordance between them. Our patients were followed up for 6 months duration
Results: Our findings demonstrated that the response to CRT resulted in improvement of NYHA class [p-value 0.04], LV EF by 2D and 3D echocardiography [P value <0.001 for both] with significant increase in LV 3D SV [p value 0.001], and significant reduction of LA diameter [p-value 0.03], LVESD diameter, 2D and 2D LVESV [P value 0.026, 0.026 respectively], however there was no any statistically significant difference between both groups
Conclusions: No additional benefit of selecting LV lead position pre CRT insertion to be concordant with the latest myocardial segment in reaching the minimal systolic volume assessed by 3D echocardiography