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Idiopathic ventricular arrhythmia ablation - a center experience
Session:
Posters (Sessão 6 - Écran 2) - Arrítmias 6 - Arrítmias Ventriculares 2
Speaker:
Joana Brito
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Brito; Pedro Silvério António; Afonso Nunes Ferreira; Gustavo Silva; Luís Carpinteiro; Sara Couto Pereira; Beatriz Valente Silva; Pedro Alves da Silva; Ana Margarida Martins; Ana Bernardes; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Idiopathic ventricular arrhythmia (IVA) is defined as ventricular tachycardia (VT) and premature ventricular beats (PVC) in the absence of structural heart disease or in whom site of origin is independent from structural abnormalities. Generally, IVA are associated with good long-term prognosis. Catheter ablation (CA) is the treatment of choice in highly symptomatic PVC, induced tachycardiomyopathy or PVC with malignant presentation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To describe a population referred for IVA CA and the efficacy and safety of IVA CA.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Consecutive patients (pts) referred for IVA CA from January 2015 to June 2021 were included. All pts were telemonitored and submitted to CA if there was a documentation of frequent spontaneous PVC, if PVC were induced by effort or isoprenaline or previously documented VT. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Baseline and follow-up clinical, laboratory and intraprocedural data were collected. Acute procedural success was defined as procedural complete suppression of IVA. Long-term success was defined as either a reduction of 80% of PVC burden or absence of VT recurrence.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">75 pts were included (mean 51±16 age, 51.3% male). Mean LVEF was 50.53 ± 19.5% and 17% had Heart Failure. Frequent PVC (23.2±14%) was the main reason for CA referral (57.3%), followed by nonsustained (33.3%) and sustained VT (9.3%). Palpitations were the most frequent symptom (61.3%), although 14.7% presented with syncope or hemodynamic compromise. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In 55 pts (73.3%) IVA mapping was feasible and were submitted to ablation. Acute success was observed in 48 patients (87.2%). The distribution of site of origin was the following: RVOT in 37.3%, LVOT in 26.7% and away from the LVOT in 9.3% – figure 1. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Procedure complications occurred in 9 (12%) pts, the most common being pericardial effusion resolved with pericardial drainage. In 2 patients transient vasopressor support was required.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Long-term success was observed in 40 (83.3%) pts independent from the site of origin. The mean PVC burden reduction was 91±14%, with significant differences among the sites of origin, slightly inferior in RVOT (88%, p = 0.047) – figure 2. Two pts underwent redo procedures. Successful CA allowed a follow-up free from antiarrhythmic drug in 41 patients (85.4% vs 52%, p = 0.002).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our cohort a significant percentage of IVA had a site of origin in the LVOT or LV. Idiopathic VT ablation is a safe procedure with a significant long-term impact free from IVA and antiarrhythmic drug. </span></span></p>
Slides
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