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EKG localization of idiopathic PVC origin before ablation: Comparison of different algorithms.
Session:
Painel 4 - Arritmologia 9
Speaker:
Gustavo Rodrigues
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.3 Ventricular Arrhythmias and SCD - Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Gustavo Da Rocha Rodrigues; Fabio Klemz; Diogo Cavaco; João Carmo; Daniel Nascimento Matos; Maria Salomé Carvalho; José Alencar; Flávio Mendonça; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Francisco Bello Morgado; Pedro Adragão
Abstract
<p><strong>Introduction</strong>: In patients without structural heart disease, localization of idiopathic premature ventricular contraction (PVC) can be pursued through twelve-lead electrocardiographic (EKG) analysis. Non invasive EKG localization of PVCs allows a better risk assessment of an ablation procedure and can guide mapping strategy during invasive localization of the site origin on the electrophysiologic (EP) study. We aimed to evaluate rate of success of PVC ablation and compare the accuracy of different algorithms intending to predict PVC origin site trough EKG analysis.</p> <p><strong>Methods</strong>: Through the analysis of the EKG of the patients submitted to first attempt PVC endocardial ablation between January 2017 and November 2019, with acute suppression of PVC during radiofrequency application, the capacity of different algorithms (Ouyang et al, Yoshida et al; Betensky et al & Enriquez et al) to predict the origin site, was evaluated. Structural heart disease was excluded through magnetic resonance and echocardiogram. Both high density activation mapping tools and pace mapping were used in most cases. SPSS v21 was used for statistical analysis.</p> <p><strong>Results</strong>: From 2017 till 2019, 56 patients without structural heart disease were submitted to first attempt of endocardial ablation of PVC, which was successful in 42 patients (75%). Half of the patients were male (N=28), and median age was 51 ± 16,7 years. Common cardiovascular risk factors and use of medication are described on table 1.</p> <p>Considering only the cases with acute suppression of PVC, the site with earliest activation was right sided in most EP studies (60%, N=25). Ouyang et al indexes (R-wave duration index e R/S wave amplitude index) revealed the higher accuracy (86% for both), followed by Yoshida et al (V2S/V3R index) with 81% and Betensky et al index (V2 transition ratio) with 76% of precision localizing the side of origin of PVCs (right vs left sided). Enriquez et al recent algorithm which aims for a more precise localization of the site of origin of PVC failed in most cases (N=25, 60%).</p> <p><strong>Conclusion</strong>: In our cohort of patients without structural heart disease, the indexes described by Ouyang et al localized PVC in 86% of cases. PVC endocardial ablation was successful in the majority of cases.</p>
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