Electrocardiographic algorithms to guide a management strategy of idiopathic outflow tract ventricular arrhythmias

The current guidelines of the European Society of Cardiology outlined electrocardiographic (ECG) differentiation of the site of origin (SoO) in patients with idiopathic ventricular arrhythmias (IVAs). The aim of this study was to compare 3 ECG algorithms for differentiating the SoO and to determine their diagnostic value for the management of outflow tract IVA. We analyzed 202 patients (mean age [SD]: 45 [16.7] years; 133 women [66%]) with IVAs with the inferior axis (130 premature ventricular contractions or ventricular tachycardias from the right ventricular outflow tract [RVOT]; 72, from the left ventricular outflow tract [LVOT]), who underwent successful radiofrequency catheter ablation (RFCA) using the 3‑dimensional electroanatomical system. The ECGs before ablation were analyzed using custom‑developed software. Automated measurements were performed for the 3 algorithms: 1) novel transitional zone (TZ) index, 2) $V_{2}S/V_{3}R$, and 3) $V_{2}$ transition ratio. The results were compared with the SoO of acutely successful RFCA. The $V_{2}S/V_{3}R$ algorithm predicted the left‑sided SoO with a sensitivity and specificity close to 90%. The TZ index showed higher sensitivity (93%) with lower specificity (85%). In the subgroup with the transition zone in lead V3 (n = 44, 15 from the LVOT) the sensitivity and specificity of the V2– transition‑ratio algorithm were 100% and 45%, respectively. The combined TZ index+$V_{2}S/V_{3}R$ algorithm (LVOT was considered only when both algorithms suggested the LVOT SoO) can increase the specificity of the LVOT SoO prediction to 98% with a sensitivity of 88%. The combined TZ‑index and $V_{2}S/V_{3}R$ algorithm allowed an accurate and simple identification of the SoO of IVA. A prospective study is needed to determine the strategy for skipping the RVOT mapping in patients with LVOT arrhythmias indicated by the 2 combined algorithms

Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry)

Introduction: Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long-term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported. Objectives: This aim of the study was to determine the short- and long-term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. Patients and methods: This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34–64) from the “Electra” Registry (2005–2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero-fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy-based RFA. Data on clinical history, complications after RFA, echocardiography, and 24-hour Holter monitoring were collected. The follow-up was 12 months or longer. Results: There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58–95), median follow-up, 32 months (IQR, 12–70). Acute and long-term procedural success rates were 93% and 86%, respectively. The long-term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long-term follow-up, no abnormalities were found within the aortic root. Conclusions: Ablation of VA within the aortic cusps is safe and effective in long-term follow-up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities

Angiogram miesiącaZawał serca u chorego z mnogimi tętniakami naczyń wieńcowych

We present a case of a 53-year-old smoking patient with myocardial infarction, in whom coronary angiography revealed many coronary arteries aneurysms, without substantial epicardial vessel narrowings. Patient was medically treated with a good outcome

Chorzy trudni nietypowiZespół Brugadów – niedoceniana przyczyna zgonów u osób bez organicznej choroby serca

We present a case of a 61-year-old man with a history of syncope and sudden cardiac arrest due to ventricular fibrillation, with the symptoms of spontaneous electrocardiographic changes characteristic for the Brugada syndrome. The patient received an implantable cardioverter-defibrillator. This patient was previously hospitalised in 2003, when the diagnosis of atrio-ventricular block has been established and in 2006, when he had chest pain and was operated because of the right coronary artery ostium haematoma. However, the diagnosis of Brugada syndrome was not established

Ablacja RF substratu arytmii i kardioneuroablacja - leczenie skojarzone u chorej z napadowym częstoskurczem węzłowym i zaburzeniami przewodzenia przedsionkowo-komorowego

We describe a case of a 35 year-old woman with AVNRT and AVB successfully treated with radiofrequency ablation. Prior to the procedure, PR interval was very prolonged (420 ms) and second degree Wenckebach AV block during sinus rythm with heart rate below 80/min was seen. After the successful RF ablation an improvement in atrio-ventricular conduction with disappearance of Wenckebach periodicity was achieved. This case shows that there is a possibility of successful elimination of slow pathway with improvement in AV conduction. Kardiol Pol 2010; 68, 6: 720-72