Authors
Iplevich Yu.A., Korolev S.V.
Federal Scientific and Clinical Center for Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow
Abstract
To date, ventricular extrasystole is one of the most common types of arrhythmias and occurs in 5% of healthy individuals of young age and up to 50% in Holter monitoring in the same group of individuals. The treatment of ventricular extrasystole is a complex and multicomponent task, including long-term selection of antiarrhythmic therapy, or requiring multistage RFA, which increases the probability of complications in the patient, as well as, in some cases, does not lead to sufficient effectiveness in the long term, leading to deterioration of the patient’s condition. It is proved that in patients with severe concomitant pathology, such as ischemic heart disease, myocardial infarctions, CHF, in the presence of frequent LES, the patient’s life prognosis worsens, and may also lead to the development of life-threatening arrhythmias, in particular, ventricular fibrillation. Therefore, we present a case of RFA in a patient with frequent polymorphic VES and reduced LV ejection fraction due to a long coronary history.
Aim. To demonstrate a clinical case of successful treatment of polymorphic left ventricular extrasystole in an ischemic patient using one-stage radiofrequency treatment of the dominant arrhythmia focus.
Methods. The patient underwent radiofrequency exposure using the CARTO 3 navigation system (Biosense Webster Inc, USA). Bipolar substrate mapping of the left ventricle with standard settings (normal tissue >1.5 mV and scar tissue <0.5 mV) was performed, which was supplemented with parallel activation mapping of two extrasystolic morphologies and stimulation mapping of extrasystoles. RFA was performed using a ThermoCool SmartTouch© catheter. Exposures were performed with exposure power parameters of 50 W, the exposure cutoff was a stable ablation time of 60 sec, and the RF catheter was irrigated with isotonic NaCl solution at a solution delivery rate of 30 ml/min during exposure application.
Results. At the moment of admission the patient had 12 thousand polymorphic ventricular extrasystoles predominantly of 2 morphologies. After surgical intervention on the next day of discharge the patient had no ventricular extrasystoles according to ECG and Holter monitoring data.
Conclusion. According to the results of the clinical case the efficacy of performing a one-stage ablation of ventricular extrasystole of two morphologies when acting on the dominant source in an ischemic patient was demonstrated. In the presence of persistent absence of extrasystole in the future, this will facilitate the selection of antiarrhythmic therapy and improve the long-term prognosis of the patient’s life.
Keywords: ventricular extrasystole, radiofrequency ablation, catheter treatment, ischemic heart disease.
References
1. Ng GA. Treating patients with ventricular ectopic beats. Heart. 2006; 92: 1707-1712. doi: 10.1136/hrt.2005.067843.
2. Kim YG, Choi YY. Premature ventricular contraction increases the risk of heart failure and ventricular tachyarrhythmia. Published online 2021 Jun 16. doi: 10.1038/s41598-021-92088-0.
3. Jouven X, Zureik M, Desnos M, Courbon D, Ducimetière P. Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med. 2000; 343(12): 826-33. doi: 10.1056/ NEJM200009213431201.
4. Stone NJ, The Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardio (GISSI)-Prevenzione Trial on fish oil and vitamin E supplementation in myocardial infarction survivors. Curr Cardiol Rep. 2000; 2(5): 445-51. doi: 10.1007/s11886-000-0059-5.
5. Duffee DF, Shen WK, Smith HC. Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. Mayo Clin Proc. 1998; 73: 430-433. doi: 10.1016/S0025-6196(11) 63724-5.
6. Yarlagadda RK, et al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation. 2005; 112: 1092-1097. doi: 10.1161/ CIRCULATIONAHA.105.546432.
7. Cantillon DJ. Evaluation and management of premature ventricular complexes, Cleve Clin J Med. 2013; 80(6): 377-87. doi: 10.3949/ ccjm.80a.12168.
8. Cronin E, Bogun F, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. EP Europace. 2019; 21(8): 1143-1144. doi:10.1093/europace/euz132.
