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Jiang Z, Guo C, Liu Q, Tian Y, Tian L, Yang Y, Wang J, Chen C, Zheng Y, Li Y, Ou Q, Yang L. Outcomes of single-procedure radiofrequency catheter ablation for idiopathic ventricular arrhythmias: a single-centre retrospective cohort study. BMJ Open 2024; 14:e081815. [PMID: 38382956 PMCID: PMC10882318 DOI: 10.1136/bmjopen-2023-081815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference. DESIGN Retrospective cohort study. SETTING Patient data were collected from a tertiary hospital in Guizhou, China. PARTICIPANTS Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled. OUTCOME MEASURES Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified. RESULTS The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence. CONCLUSIONS Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.
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Affiliation(s)
- Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chuxian Guo
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qifang Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ye Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ying Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Junxian Wang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chunyan Chen
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yaxi Zheng
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yu Li
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qiaoqiao Ou
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Long Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
- Guizhou Medical University, Guiyang, Guizhou, China
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Lu YY, Chen YC, Lin YK, Chen SA, Chen YJ. Electrical and Structural Insights into Right Ventricular Outflow Tract Arrhythmogenesis. Int J Mol Sci 2023; 24:11795. [PMID: 37511554 PMCID: PMC10380666 DOI: 10.3390/ijms241411795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
The right ventricular outflow tract (RVOT) is the major origin of ventricular arrhythmias, including premature ventricular contractions, idiopathic ventricular arrhythmias, Brugada syndrome, torsade de pointes, long QT syndrome, and arrhythmogenic right ventricular cardiomyopathy. The RVOT has distinct developmental origins and cellular characteristics and a complex myocardial architecture with high shear wall stress, which may lead to its high vulnerability to arrhythmogenesis. RVOT myocytes are vulnerable to intracellular sodium and calcium overload due to calcium handling protein modulation, enhanced CaMKII activity, ryanodine receptor phosphorylation, and a higher cAMP level activated by predisposing factors or pathological conditions. A reduction in Cx43 and Scn5a expression may lead to electrical uncoupling in RVOT. The purpose of this review is to update the current understanding of the cellular and molecular mechanisms of RVOT arrhythmogenesis.
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Affiliation(s)
- Yen-Yu Lu
- Division of Cardiology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei City 22174, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City 24257, Taiwan
| | - Yao-Chang Chen
- Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan
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