Aquino BH, Sánchez EY, Añas MML, Bozada NKI, De la Fuente MC, Enríquez SA, Rojel MU

Language: English
References: 23
Page: 126-130
PDF size: 309.55 Kb.

ABSTRACT

Introduction: Most ventricular arrhythmias are related to structural heart disease. When they occur in anatomically normal hearts are known as idiopathic arrhythmias. The highest percentage of premature ventricular complexes (PVC) is originated in the right ventricular outflow tract. However, less frequent sites have been described, such as the tricuspid annulus. Irregular rhythm along with a high percentage of arrhythmic burden (AB) have an important role in the deterioration of left ventricular function. Objective: To describe the return to normal ventricular function after PVC radiofrequency ablation (RFA). Case study: A 75-year-old man, without relevant history, presented with mild exertion dyspnea and frequent palpitations. The physical examination was normal, the 12-lead electrocardiogram showed premature ventricular contractions with a left bundle branch block (LBBB) pattern and superior axis. A Holter monitoring documented a 35% arrhythmic burden and transthoracic echocardiography demonstrated an LVEF of 40% and global hypokinesia, without valvular heart disease. An electrophysiological study was conducted with three-dimensional mapping that observed the origin of the PVC at the septal tricuspid annulus. RFA was performed in this area, resulting in the immediate disappearance of PVC. Results: At 3 months a 24-hour Holter monitoring showed 0.02% of AB and a transthoracic echocardiogram showed LVEF of 65%. Conclusion: Premature ventricular contractions originating from the tricuspid annulus are an uncommon cause of tachycardiomyopathy and RFA treatment is safe and effective.

REFERENCES

1. Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E et al. EHRA/HRS Expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace. 2009; 11 (6): 771-817.

2. Ataklte F, Erqou S, Laukkanen J, Kaptoge S et al. Metaanalysis of ventricular premature complexes and their relation to cardiac mortality in general populations; Department of Medicine, King’s College London, London, United Kingdom. Am J Cardiol. 2013; 112 (8): 1263-1270.

3. Yokokawa M, Good E, Crawford T et al. Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes. Heart Rhythm. 2013; 10 (2): 172-175.

4. Hasdemir C, Ulucan C, Yavuzgil O et al. Tachycardia induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: the incidence, clinical and electrophysiologic characteristics, and the predictors. J Cardiovasc Electrophysiol. 2011; 22 (6): 663-668.

5. Nakagawa M, Takahashi N, Nobe S et al. Gender differences in various types of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol. 2002; 13: 633-638

6. Miles WM. Idiopathic ventricular outflow tract tachycardia: where does it originate? J Cardiovasc Electrophysiol. 2001; 12 (5): 536-537.

7. Tada H, Tadokoro K, Ito S, Naito S, Hashimoto T, Miyaji K et al. Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency cathetheter ablation. Heart Rhythm. 2007; 4: 7-16.

8. Yue-Chun L, Wen-Wu Z, Na-Dan Z, Teng Z, Pin- Xiao W, Bei G et al. Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus: results of radiofrequency catheter ablation in thirty-five patients. BMC Cardiovasc Disord. 2012; 12: 32.

9. Mountantonakis SE, Frankel DS, Gerstenfeld EP, Dixit S, Lin D, Hutchinson MD et al. Reversal of outflow tract ventricular premature depolarization-induced cardiomyopathy with ablation: effect of residual arrhythmia burden and preexisting cardiomyopathy on outcome. Heart Rhythm. 2011; 8 (10): 1608-1614.

10. Zhong L, Lee Y, Huang X, Asirvatham S, Shen W, Friedman P et al. Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart Rhythm. 2014; 11 (2): 187-193.

11. Gopinathannair R, Etheridge S, Marchlinski F, Spinale F, Lakkireddy D, Olshansky B. Arrhythmia-induced cardiomyopathies: mechanisms, recognition, and management. J Am Coll Cardiol. 2015; 66 (15): 1714- 1728.

12. Simantirakis EN, Koutalas EP, Vardas PE. Arrhythmia induced cardiomyopathies: the riddle of the chicken and the egg still unanswered? Europace. 2012; 14 (4): 466-473.

13. Varela G, Tortajada G, Spera E, Reyes Caorsi W. Taquimiocardiopatía por taquicardia ventricular idiopática del anillo tricuspídeo: ablación utilizando navegador y catéter Ensite Array. Rev Urug Cardiol. 2014; 29 (2): 173-180.

14. Cismaru G, Mester P, Muresan L, Rosu R, Gusetu G, Puiu M et al. Idiopathic ventricular premature contractions originating from the postero-lateral tricuspid annulus leading to left ventricular disfunction. Int J Clin Exp Med. 2015; 8 (3): 4690-4693.

15. Sugumar H, Prabhu S, Voskoboinik A, Kistler P. Arrhythmia induced cardiomyopathy. J Arrhythm. 2018; 34 (4): 376-383.

16. Fenelon G, Wijns W, Andries E, Brugada P. Tachycardiomyopathy: mechanisms and clinical implications. Pacing Clin Electrophysiol. 1996; 19 (1): 95-106.

17. Kanei Y, Friedman M, Ogawa N, Hanon S, Lam P, Schweitzer P. Frequent premature ventricular complexes originating from the right ventricular outflow tract are associated with left ventricular dysfunction. Ann Noninvasive Electrocardiol. 2008; 13: 81-85.

18. Lee A, Walters TE, Gerstenfeld EP, Haqqani HM. Frequent ventricular ectopy: implications and outcomes. Heart Lung Circ. 2019; 28 (1): 178-190.

19. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C et al. Relationship betweenburden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010; 7: 865-869.

20. Wang JS, Shen YG, Yin RP, Thapa S, Peng YP, Ji KT et al. The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease. BMC Cardiovasc Disord. 2018; 18 (1): 177.

21. Fichtner S, Senges J, Hochadel M, Tilz R, Willems S, Eckardt L et al. Safety and efficacy in ablation of premature ventricular contraction: data from the German ablation registry. Clin Res Cardiol. 2017; 106 (1): 49- 57.

22. Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R et al. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol. 2015; 1 (3): 116-123.

23. Bogun F, Crawford T, Reich S et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm. 2007; 4: 863-867.