Long Term Results of Radio Frequency Ablation of Right Ventricular Outflow Tract Tachycardia
Abstract
Background. Right Ventricular Outflow Tract (RVOT) tachycardia is frequentlyfound in clinical practice. Despite of its good prognosis no need it
usually affects the reproductive age (20-40 years) and can be very symptomatic.
Radio frequency ablation (RFA) is a recommended therapeutic
option of RVOT tachycardia. The aim of this study is to evaluate longterm
resultsof RFA in National Cardiovasxular Center Harapan Kita.
Method. A retrospective cohort study conducted to subjects with RVOT
tachycardia who underwent RFA during period of 2005-2011. Clinical
characteristics are revealed from medical record and electrophysiology
characteristics are revealed from electrophysiology recording system
(PruckaTMandWorkmateTM). ECG morphology assessed by 2 observers
using digimatic calliper MitutoyoTM. Patients that received pharmacological
therapy act as control group. All patients are observed up to 1 year.
Results. Sixty two patients underwent RFA (mean age of 43,56 ± 11,77
year,46 female). ECG morphologies are all left bundle branch blok (LBBB),
inferior axis, transtitional zone ? V4. Based on ECG morphology, septal site
are majority of cases. Mean EA (earliest activation) is 41,26 ± 16,94 ms,
median 39,50 ms. An acute successful rate of RFA is 79%.Long termsuccess
rate is 83,9 % as compare to only 40,9% in medical therapy group(RRR
77%, p=0.001). Septal origin site is an independent factor of success of
RFA RVOT tachycardia.
Conclusion. RFA of RVOT tachycardia is safe and effective with better
longterm result as compare to pharmacological therapy.
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References
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SrivathsanKomandoor, Steven J Lester, Appleton P Christopher, Scott RP Luis, Munger M Thomas. Ventricular tachycardia in the absence of structural heart disease. Indian Pacing Electrophysiol J 2005;5:106-21.
Milea M William. Idiopathic ventricular outflow tract tachycardia: where does it originate? J CardiovascElectrophysiol 2001;12:536-7.
Kim J Bae, Kim J Youn. Clinical characteristics and prognosis of Korean patients with ventricular tachycardia. Korean J Med 2006; 71:276-83.
Zipes P Douglas, Camm A Jhon, Borggrefe Martin, et al. ACC/AHA/ESC Guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2006; 8: 746-837.
Xiao Yu Wu, Zhao Guang Liang , Zhen Than, Hong YueGu, Shu Zhang and Wei Min Li. Radiofrequency catheter ablation of idiopathic ventricular tachycardia and symptomatic premature ventricular contraction originating from valve annulus. Chinese Medical Journal 2008;22:2241-5.
KrittayaphongRungroj, SriratanasathavornCharn, ChatkanokDumavibhat, et al. Electrocardiographic predictors of long-term outcomes after radiofrequency ablation in patients with right-ventricular outflow tract tachycardia. Europace 2006;8:601-6
Ito Sachiko, Tada Hiroshi,NaitoShigeto, et al. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia, abstract. J CardiovascElectrophysiol 2003;114:1280-6.
Hildegard Tanner, Hindrikcs G, Schirdewahn P, Richard Kobza, AnjaDorszewski, Piorkowski C, et al. Outflow Tract Tachycardia With R/S Transition in Lead V3, Six Different Anatomic Approaches for Successful Ablation. J Am CollCardiol 2005;45:418 -23.
Zhang Fengxiang, Chen Minglon, Yang Bing, et al. Electrocardiographic algorithm to identify the optimal target ablation site for idiopathic right ventricular outflow tract ventricular premature contraction. Europace 2009; 11:1214–20.
O’Donnell D, Cox D, Bourke J, Mitchell L, Furniss S. Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia. Eur Heart J 2003;9:801-10.
Yamashina Yoshihiro, Yagi Tetsuo, Namekawa Akio, et al. Distribution of successful ablation sites of idiopathic right ventricular outflow tract tachycardia, abstract. Pacing and clinical electrophysiology 2009;32:727-33.
NasirKhurram, Bomma Chandra, TandriHarikrishna, et al. Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia/ Cardiomyopathy According to Disease Severity: A Need to Broaden Diagnostic Criteria. Circulation 2004;110:1527-34.
Stevenson G William, Soejima Kyoko. Interventional cardiac electrophysiology, Catheter Ablation for Ventricular Tachycardia. Circulation. 2007;115:2750- 60.
C.Lin J. Physical Aspects of Radiofrequency Ablation In: Shoei K Stephen Huang DJW, editor. Radiofrequency catheter ablation of cardiac arrhytmias, Basic consepts and clinical applications. 2 ed. New York: Futura Publishing Company; 2000. p. 12-24.
Friedman A Paul, Asirvatham J Samuel , Grice Suellen, Glikson Michael, Munger M Thomas, Rea F Robert, et al. Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia. J Am CollCardiol. 2002;39:1808-12.
Natale Andrea. Management of ventricular tachycardia: Identification dan therapy guideline for multidisciplinary doctors. Gujarat medical journal 2010;65:36-42.
JurgenSchreieck GH, Alexander Pustowoit, Claus Schmitt. Ventricular tachycardia. In: C. Schmitt ID, B. Zrenner, editor. Catheter ablation of cardiac arrhytmias A Practical approach: Springer. p. 185.
Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers
Rasyid H El dkk: Keberhasilan Jangka Panjang Ablasi Takikardia RVOT
Jurnal Kardiologi Indonesia • Vol. 34, No. 1 • Januari - Maret 2013 13
for right ventricular outflow tract tachycardia. Am Heart J. 2000;6:1009-13.
Schalij J Martin, Rugge Van Paul, SiezengaMachiel, Van der Velde T Enno. Endocardial Activation Mapping of Ventricular Tachycardia in Patients : First Application of a 32-Site Bipolar Mapping Electrode Catheter. Circulation 1998;98:2168-79.
Luz Maria Rodriguez, Joep L R M smeets, Carl Timmermans, Hein JJ Wellens HJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia.Am J Cardiol. 1997;79:9309–14.
Vestal Marivic, Shien Wen Ming, JouYeh San, Chieh Wang Chun, Chung Lin Fun and Wu Delon. Electrocardiographic predictors of failure and recurrence in patients with idiopathic right ventricular outflow tract tachycardia and ectopy who underwent radiofrequency catheter ablation.J Electrocardiol. 2003;36:327-32.
Fogoros N Richard. The cardiac electrical system.In Dudziak Simone, editor.Electrophysiologic testing. 4 ed. Hong Kong; Blackwell: 2006 p 3-11.
Mond G Harry, Hillock J Richard, Stevenson H Irine, MacGavigan D Andrew. The Right ventricular outflow tract.The road to septal pacing. Pacing and Clinical Electrophysiology 2007;30:482-491
Tanaka Y, Tada H, Ito S, Naito S, Higuchi K, Kumagai K, et al. Gender and age differences in candidates for radiofrequency catheter ablation of idiopathic ventricular arrhythmias. Circ J 2011;75:1585-91.
SrivathsanKomandoor, Steven J Lester, Appleton P Christopher, Scott RP Luis, Munger M Thomas. Ventricular tachycardia in the absence of structural heart disease. Indian Pacing Electrophysiol J 2005;5:106-21.
Milea M William. Idiopathic ventricular outflow tract tachycardia: where does it originate? J CardiovascElectrophysiol 2001;12:536-7.
Kim J Bae, Kim J Youn. Clinical characteristics and prognosis of Korean patients with ventricular tachycardia. Korean J Med 2006; 71:276-83.
Zipes P Douglas, Camm A Jhon, Borggrefe Martin, et al. ACC/AHA/ESC Guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2006; 8: 746-837.
Xiao Yu Wu, Zhao Guang Liang , Zhen Than, Hong YueGu, Shu Zhang and Wei Min Li. Radiofrequency catheter ablation of idiopathic ventricular tachycardia and symptomatic premature ventricular contraction originating from valve annulus. Chinese Medical Journal 2008;22:2241-5.
KrittayaphongRungroj, SriratanasathavornCharn, ChatkanokDumavibhat, et al. Electrocardiographic predictors of long-term outcomes after radiofrequency ablation in patients with right-ventricular outflow tract tachycardia. Europace 2006;8:601-6
Ito Sachiko, Tada Hiroshi,NaitoShigeto, et al. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia, abstract. J CardiovascElectrophysiol 2003;114:1280-6.
Hildegard Tanner, Hindrikcs G, Schirdewahn P, Richard Kobza, AnjaDorszewski, Piorkowski C, et al. Outflow Tract Tachycardia With R/S Transition in Lead V3, Six Different Anatomic Approaches for Successful Ablation. J Am CollCardiol 2005;45:418 -23.
Zhang Fengxiang, Chen Minglon, Yang Bing, et al. Electrocardiographic algorithm to identify the optimal target ablation site for idiopathic right ventricular outflow tract ventricular premature contraction. Europace 2009; 11:1214–20.
O’Donnell D, Cox D, Bourke J, Mitchell L, Furniss S. Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia. Eur Heart J 2003;9:801-10.
Yamashina Yoshihiro, Yagi Tetsuo, Namekawa Akio, et al. Distribution of successful ablation sites of idiopathic right ventricular outflow tract tachycardia, abstract. Pacing and clinical electrophysiology 2009;32:727-33.
NasirKhurram, Bomma Chandra, TandriHarikrishna, et al. Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia/ Cardiomyopathy According to Disease Severity: A Need to Broaden Diagnostic Criteria. Circulation 2004;110:1527-34.
Stevenson G William, Soejima Kyoko. Interventional cardiac electrophysiology, Catheter Ablation for Ventricular Tachycardia. Circulation. 2007;115:2750- 60.
C.Lin J. Physical Aspects of Radiofrequency Ablation In: Shoei K Stephen Huang DJW, editor. Radiofrequency catheter ablation of cardiac arrhytmias, Basic consepts and clinical applications. 2 ed. New York: Futura Publishing Company; 2000. p. 12-24.
Friedman A Paul, Asirvatham J Samuel , Grice Suellen, Glikson Michael, Munger M Thomas, Rea F Robert, et al. Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia. J Am CollCardiol. 2002;39:1808-12.
Natale Andrea. Management of ventricular tachycardia: Identification dan therapy guideline for multidisciplinary doctors. Gujarat medical journal 2010;65:36-42.
JurgenSchreieck GH, Alexander Pustowoit, Claus Schmitt. Ventricular tachycardia. In: C. Schmitt ID, B. Zrenner, editor. Catheter ablation of cardiac arrhytmias A Practical approach: Springer. p. 185.
Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers
Rasyid H El dkk: Keberhasilan Jangka Panjang Ablasi Takikardia RVOT
Jurnal Kardiologi Indonesia • Vol. 34, No. 1 • Januari - Maret 2013 13
for right ventricular outflow tract tachycardia. Am Heart J. 2000;6:1009-13.
Schalij J Martin, Rugge Van Paul, SiezengaMachiel, Van der Velde T Enno. Endocardial Activation Mapping of Ventricular Tachycardia in Patients : First Application of a 32-Site Bipolar Mapping Electrode Catheter. Circulation 1998;98:2168-79.
Luz Maria Rodriguez, Joep L R M smeets, Carl Timmermans, Hein JJ Wellens HJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia.Am J Cardiol. 1997;79:9309–14.
Vestal Marivic, Shien Wen Ming, JouYeh San, Chieh Wang Chun, Chung Lin Fun and Wu Delon. Electrocardiographic predictors of failure and recurrence in patients with idiopathic right ventricular outflow tract tachycardia and ectopy who underwent radiofrequency catheter ablation.J Electrocardiol. 2003;36:327-32.
Fogoros N Richard. The cardiac electrical system.In Dudziak Simone, editor.Electrophysiologic testing. 4 ed. Hong Kong; Blackwell: 2006 p 3-11.
Mond G Harry, Hillock J Richard, Stevenson H Irine, MacGavigan D Andrew. The Right ventricular outflow tract.The road to septal pacing. Pacing and Clinical Electrophysiology 2007;30:482-491
Tanaka Y, Tada H, Ito S, Naito S, Higuchi K, Kumagai K, et al. Gender and age differences in candidates for radiofrequency catheter ablation of idiopathic ventricular arrhythmias. Circ J 2011;75:1585-91.
Published
2013-10-14
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How to Cite
Rasyid, H., & Yuniadi, Y. (2013). Long Term Results of Radio Frequency Ablation of Right Ventricular Outflow Tract Tachycardia. Indonesian Journal of Cardiology, 34(1), 5-13. https://doi.org/10.30701/ijc.v34i1.298
Section
Clinical Research
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