Ventricular Arrythmia Clinical Trial
Official title:
Safety and Efficacy of Catheter Ablation of Idiopathic Ventricular Arrhythmias Arising From Cardiac Outflow Tracts
Ventricular arrhythmias arising from cardiac outflow tract affect quality of life and can
cause decrease in left ventricular ejection fraction.
Drugs used for treating those arrhytmias may be ineffective or may have side effects.
Radiofrequency catheter ablation can be used safely for treatment of outflow tract
arrhythmias.
There are different sites where those ventricular arrhythmias may originates, each site has
different electrocardiographic characteristics, different procedural success rates and
challenges in localization and ablation.
The right and left ventricular outflow tracts (RVOT/LVOT) are the most common sites of origin
for idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs) in
patients without structural heart disease.1
Frequent PVCs was associated with PVC-induced cardiomyopathy, and radiofrequency (RF)
catheter ablation of frequent PVCs was associated with improvement of left ventricular
ejection fraction (LVEF).2
The most common underlying pathophysiological mechanism was identified to be triggered
activity and RF catheter ablation treatment is highly effective with low complication
rates.1,3 Drug therapy has limited effectiveness (in case β-blockers and calcium-channel
blockers) or drug-related side effects ( in case of flecainide, propafenone and amiodarone).4
RF catheter ablation is recommended in cases of high PVC burden associated with decreased LV
ejection fraction (LVEF) or in highly symptomatic patients despite optimal drug therapy.3
Although the RVOT is the most common site (about 70-80% of cases) for idiopathic VAs1,5, only
few studies have reported on the prevalence and RF catheter ablation of ventricular
arrhythmias (VAs) arising from the pulmonary artery (21-46% among the RVOT VAs)6 and even
less prevalence is reported in VAs arising from the pulmonary sinus cusps (11%).7
Compared with VAs originating from the RVOT, ablation of LVOT-VAs is more complex and
reported to be 12-45% of all idiopathic VAs.8-11 The success rate of ablation of LVOT-VA
sites was previously reported to be lower (55-60%) without using antegrade/transseptal
approaches.12,4 Rarely, it requires epicardial ablation via the GCV/AIV or subxiphoid
puncture.13,14
There are some cases in which RF catheter ablation cannot successfully be performed from
either LVOT or RVOT. In such cases the VAs may originate from the LV-summit which is the most
common site of idiopathic epicardial VAs from the LVOT region.13
Although most idiopathic VAs originating from the cardiac OTs are suitable targets for
endocardial RF catheter ablation, a small percentage of failures in these patients may be
because of an inaccessible site of origin from epicardial or intramural septal
locations.15The identification, mapping and RF catheter ablation of these idiopathic VAs may
be challenging for the electrophysiologist and need special consideration.16
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