RT-152
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Catheter ablation of ventricular
ectopic beats in patients with subtle right ventricle abnormalities revealed by magnetic
resonance imaging
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Giuseppe Oreto*, Carlo Pappone,
Maria Luisa Loricchio, Renata Mellone**, Mariano Rillo, Filippo Lamberti, Maria Pia
Calabro*, Alessandro Del Maschio**, Sergio Chierchia.
**S. Raffaele Hospital, Department of Cardiology, and Department of Radiology,
Milan,
*University of Messina, Department of Cardiology, Messina, Italy
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Abstract
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Background. Catheter ablation is
commonly used to treat several arrhythmias, including "idiopathic" ventricular
tachycardia, but only a few patients with isolated ventricular ectopic beats have been
treated with radiofrequency ablation.
Methods. Five patients (2 males, 3 females) with average age of 26
years, suffering from frequent, symptomatic, drug-resistant right ventricular outflow
tract (RVOT) ectopic beats, underwent clinical examination, echocardiogram, magnetic
resonance imaging (MRI), and electrophysiologic study followed by radiofrequency energy
delivery. The target site for ablation was identified by the earliest local endocardial
activity associated with a pacemapping resulting in paced beats identical in configuration
to spontaneous ectopic beats.
Results. Echocardiogram was normal in every patient. Magnetic
resonance revealed in 4 patients subtle right ventricle alterations consisting in focal
wall thinning (3 cases), localized contraction abnormalities (4 cases) and fatty
infiltration (1 case). Catheter ablation was successful in all patients. In 4 patients RF
application resulted in transient accelerated ventricular rhythm that was followed by
complete disappearance of ectopic beats. No procedure-related complications occurred. The
follow-up Holter recordings demonstrated absence of ventricular ectopic beats in 2
patients, and only a few ectopic beats (no more than 8/hour) in 3 patients.
Conclusions. Several otherwise "healthy" patients with
frequent RVOT ectopic beats show subtle right ventricle abnormalities that may be detected
by MRI. In these patients, catheter ablation is feasible and safe, and results in total
elimination of ectopic beats.
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Key Words
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Atrial fibrillation – RF catheter ablation
of AV junction
refractory ventricular ectopic beats, right ventricular otflow tract, right ventricle
abnormalities, magnetic resonance imaging, echocardiography, OA
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