Radiofrequency ablation of idiopathic ventricular tachycardia

Which Is The Appropriate Arrhythmia Burden To Offer RF Ablation For RVOT Tachycardias?

Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT) in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.

Palpitations: reassurance or more?

Palpitations are a common symptom and are caused by forceful or rapid beating of the heart. Palpitations can be caused by a variety of cardiac arrhythmias and careful history is invaluable in deciding appropriate investigations and management. Palpitations caused by anxiety-induced sinus tachycardia are common, but anxiety is also common in patients who have cardiac arrhythmias for which effective treatment is available. Management of palpitations depends on the type of cardiac arrhythmia; almost all arrhythmias can now be effectively treated. Radiofrequency ablation provides an effective cure for most patients with paroxysmal supraventricular tachycardia when the alternative is continuous drug therapy.