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Catheter ablation of noncoronarogenic ventricular tachyarrhythmias: Early and remote efficacy of the procedure depending on the etiology of rhythm disorders

Grokhotova V. V., Tatarsky R. B., Lebedev D. S., Lebedeva V. K., Mitrofanova L. B., Mitrofanov N. K., Pakhomov A. V., Ignatjeva E. S., Malikov K. N., Pankova I. A., Belyakova L. A., Beshchuk O. V.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: catheter ablation, treatment, tachyarrhythmia, surgical methods

DOI: 10.18087/rhj.2014.1.1859

Background. Ventricular tachyarrhythmia (VTA) is one of the most relevant problems of current cardiology because VTAs occupy the first place among causes of sudden cardiac death (SCD). The major methods for treating VTA are antiarrhythmic therapies and radiofrequency ablation. Aim. To evaluate early and remote efficacy of catheter ablation in noncoronarogenic VTA. Materials and methods. The study included 87 patients with noncoronarogenic ventricular extrasystole (VE) and / or ventricular tachycardia (VT). Endomyocardial biopsy (EMB) was performed during surgical treatment of arrhythmias. Based on EMB results, the patients were divided into three clinical and morphological groups: RA arrhythmogenic dysplasia (RAAD), myocarditis, postmyocarditis cardiosclerosis (PMCS). The groups were compared by number of documented VT episodes and ventricular fibrillation (VF) episodes; quantity and efficacy of used electrotherapy at 6, 12, 24 months, and more than 24 months after the implantation. Results. Catheter destruction was performed in 64 patients including 50 patients with VE and 14 patients with stable VT. Catheter radiofrequency (CRF) ablation of extrasystolic focus / foci was performed in all patients with VE. Catheter destruction of stable VT was performed in 14 (38 %) patients, including 11 patients who underwent VT ablation alone and 3 patients who underwent a combination treatment (CRF and cardioverter-defibrillator implantation). Early effects were observed 39 (78 %) patients with CRF for VE. In the group with stable VT, CRF was effective in 10 (71 %) patients and failed in 3 cases. In the group of patients with RAAD, catheter ablation was performed in 17 of 29 patients. Overall efficacy was 82 %; efficacy of VE elimination was 78 %, and efficacy of VT elimination was 71 %. In the group of patients with myocarditis, CRF was performed in 26 of 34 patients. Overall efficacy of the procedure was 81 %; efficacy of VE ablation was 85 % and VT – 60 %. In the group with PMCS, ablation was performed in 18 of 24 patients. In this group, efficacy of catheter ablation was the highest, 86 %; efficacy of CRF for VT was 89 %. The efficacy of VT elimination was comparable with other groups (50 %). Conclusion. EMB allows determining the etiology of ventricular arrhythmias. Major diseases found in patients with noncoronarogenic VTA using EMB were RAAD (33 %), myocarditis (39 %) and PMCS (28 %). Intraoperative efficacy of ablation for noncoronarogenic VTA was 86 % and it was not statistically significantly between the study groups. The remote efficacy was the highest in the PMCS group (100 %), high in the myocarditis group (90 %) and relatively low in patients with RAAD (67 %).
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Grokhotova V. V., Tatarsky R. B., Lebedev D. S. et al. Catheter ablation of noncoronarogenic ventricular tachyarrhythmias: Early and remote efficacy of the procedure depending on the etiology of rhythm disorders. Russian Heart Journal. 2014;75 (1):3–10

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