Radiofrequency catheter ablation of premature ventricular contractions from near the His‐bundle

Abstract

Objective This study aimed to investigate the effects of radiofrequency catheter ablation ( RFCA ) and clinical and electrophysiological characteristics in symptomatic patients with premature ventricular contractions ( PVC s) from near the His‐bundle (His‐ PVC s). Methods The patient characteristics, prevalence of complications with any life style related disease ( ALSRD ) including hypertension, dyslipidemia, or diabetes mellitus, and/or cardiovascular disease ( CVD ) including coronary artery disease, cerebrovascular disease, renal dysfunction, or cardiomyopathy, clinical status, frequency of PVC s evaluated by 24hour Holter monitoring, echocardiography including the left ventricular diastolic dysfunction ( LVDD ) parameters, and electrophysiological findings were evaluated in 14 consecutive symptomatic patients with His‐ PVC s. Results The prevalence of males, being elderly and/or slightly obese, current and/or history of smoking, ALSRD or CVD related complications, and LVDD probably resulting from ALSRD and/or CVD complications were higher in patients with His‐ PVC s. RFCA of His‐ PVC s steadily decreased the PVC frequency and improved the systolic function, LV dilation, and clinical status, but not the LVDD . There was a significant relationship between the accordance rate of the QRS polarity between sinus rhythm and His‐ PVC s and the distance between the successful ablation site and His‐bundle. Conclusion The analysis of the QRS duration and accordance rate of the QRS polarity between sinus rhythm and His‐ PVC s before the RFCA may help to determine the distance between the origin of the PVC s and His‐bundle. Further, the appropriate ablation catheter may be selected during the RFCA procedure. Finally, RFCA may be one of the most effective, feasible, and safest therapies for symptomatic patients with His‐ PVC s.

Radiofrequency catheter ablation of premature ventricular contractions from the mitral annulus in patients without structural heart disease

“…The NYHA functional status significantly improved in 20 patients in whom procedural success without any adverse effects was achieved (Table 2), and RFCA is known to be safe and effective for the treatment of arrhythmias as compared to medical therapy 1,3 . Thus, RFCA may be considered as the first choice of therapy in intolerable symptomatic patients with frequent MA‐PVCs.…”

“…2 In recent years, radiofrequency catheter ablation (RFCA) has proven to be a safe and successful therapy for arrhythmias including PVCs. 1,3 Moreover, we previously and recently reported the clinical benefit of RFCA of PVCs from the right ventricular outflow tract (RVOT-PVCs), 1 which are one of the most common types of PVCs, and from near the His-bundle, 3 which are a comparably uncommon type of PVC. In particular, eliminating frequent RVOT-PVCs by RFCA could steadily improve the clinical status.…”

“…Many patients with frequent PVCs not only often experience disabling symptoms, and sometimes, need long‐term antiarrhythmic medication, but also they can cause left ventricular (LV) dysfunction and increase the incidence of heart failure and mortality 2 . In recent years, radiofrequency catheter ablation (RFCA) has proven to be a safe and successful therapy for arrhythmias including PVCs 1,3 . Moreover, we previously and recently reported the clinical benefit of RFCA of PVCs from the right ventricular outflow tract (RVOT‐PVCs), 1 which are one of the most common types of PVCs, and from near the His‐bundle, 3 which are a comparably uncommon type of PVC.…”

Safety and efficacy of first‐line cryoablation for para‐hisian ventricular arrhythmias using a cryomapping protocol approach: A case series

“…1,2 However, catheter ablation for VAs arising from the para-Hisian region was reported to be challenging due to the risk of atrioventricular (AV) conduction disturbance. 3,4 A cryoablation system has been recently developed as an alternative approach to treat arrhythmia, and the system is considered as a feasible approach to avoid the risk of injury to conduction systems, such as the His bundle. [5][6][7][8][9] Nevertheless, there is no guarantee that AV conduction disturbances will not occur even while using cryoenergy.…”

“…Previous reports have demonstrated that para‐Hisian VAs accounted for approximately 3% of all idiopathic ventricular tachycardias 1,2 . However, catheter ablation for VAs arising from the para‐Hisian region was reported to be challenging due to the risk of atrioventricular (AV) conduction disturbance 3,4 . A cryoablation system has been recently developed as an alternative approach to treat arrhythmia, and the system is considered as a feasible approach to avoid the risk of injury to conduction systems, such as the His bundle 5‐9 .…”