Radiofrequency catheter ablation of left coronary cusp premature ventricular complex
DOI:
https://doi.org/10.18004/mem.iics/1812-9528/2024.e22132402Keywords:
Ventricular extrasystoles, ventricular outflow tract, left coronary sinus, radiofrequency catheter ablationAbstract
Premature ventricular complexes (PVC) are frequently asymptomatic and do not require antiarrhythmic treatment. Outflow tract PVC are the most common idiopathic PVC in clinical practice. The anamnesis, physical examination and electrocardiogram are essential in the diagnosis of these patients. Although PVC of the ventricular outflow tracts are considered benign, they can produce various symptoms such as dyspnea on exertion, asthenia, palpitations, dizziness, presyncope or syncope, and in those patients with very high arrhythmic burden (>24% on a 24-hour Holter monitoring), can trigger extrasystole-induced cardiomyopathy, leading to deterioration of left ventricular systolic function and ultimately heart failure. When pharmacological treatment of PVC fails, ablation of arrhythmias by radiofrequency catheter is the only effective alternative. This is the case of the 62-year-old female patient, hypertensive, dyslipidemic and a smoker, which demonstrates the safety of radiofrequency catheter ablation, the therapeutic efficacy, and the complete restoration of the ventricular function of the heart.
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References
Penela D, Falasconi G, Carreño JM, Soto-Iglesias D, Fernández-Armenta J, Acosta J, et al. A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias. J Interv Card Electrophysiol. 2023; 66: 1877-88. https://doi.org/10.1007/s10840-023-01507-x
Jáuregui B, Fernández-Armenta J, Acosta J, Penela D, Terés C, Ordóñez A, et al. Manual vs. automatic local activation time annotation for guiding Premature Ventricular Complex ablation procedures (MANIaC-PVC study). Europace. 2021; 23(8): 1285-94. https://doi.org/10.1093/europace/euab080
Marcus GM. Evaluation and Management of Premature Ventricular Complexes. Circulation. 2020; 141(17): 1404-18. https://doi.org/10.1161/CIRCULATIONAHA.119.042434
Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010;7(7): 865-9. https://doi.org/10.1016/j.hrthm.2010.03.036
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022; 43(40): 3997-4126. https://doi.org/10.1093/eurheartj/ehac262
Sánchez-Millán PJ, Gutiérrez-Ballesteros G, Molina-Lerma M, Macías-Ruiz R, Jiménez Jáimez J, Tercedor L, et al. Ablation with zero-fluoroscopy of premature ventricular complexes from aortic sinus cusps: A single-center experience. J Arrhythmia. 2021;37:1497-505. https://doi.org/10.1002/joa3.12642
Berruezo A, Penela D, Jáuregui B, Soto-Iglesias D, Aguinaga L, Ordoñez A. Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction. Europace 2019; 21(7): 1079-87. https://doi.org/10.1093/europace/euz027
Penela D, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordoñez A, Bisbal F, et al. Clinical recognition of pure premature ventricular complex-induced cardiomyopathy at presentation. Heart Rhythm 2017; 14: 1864-70. http://dx.doi.org/10.1016/j.hrthm.2017.07.025