[Effectiveness of RF ablation of ventricular ectopic beats from the right and (or) left ventricle].

UNLABELLED: There are few studies on the immediate and long term efficacy of ablation of ventricular ectopic beat (VEB) using different mapping systems arrhythmia. The aim of the study was to evaluate the efficacy of intraoperative, immediate and late outcome of RF ablation ventricular arrhythmias and a comparison of methods for identification and ablation of arrhythmia substrate.

MATERIAL AND METHODS: In 88 patients, average age 50,8+/-17,8 years old (16 to 90) with performed RF ablation of VEB from the left ventricular and (or) right ventricular. We retrospectively evaluated surgical reports and clinical records. The number of applications, energy, temperature, duration of application, impedance, radiation exposure to X-ray and the presence of obesity, myocardial infarction were evaluated. RF ablation was performed using the method of Carto or Carto and Pace mapping stimulation or Pace mapping stimulation alone. Patients were divided into 3 groups: group A - long result was positive after ablation, group B - treatment was ineffective, group C - ad hoc and postoperative result were positive but long result was negative.

RESULTS: The observation time was 30+/-11 months (3-48). An ad hoc positive end point of VEB ablation was 86%, postoperative 74%, and a distant 60%, respectively. There was 13% ineffective treatments. Carto system was used in 53 patients. In 6 (11%, group B) treatment was ineffective, the remaining 47 patients achieved complete success in 31 (58%, group A) cases, while temporary success in 16 (30%, group C) cases. The relationship between the average temperature of 57 Celcius degree during ablation (HR = 1.148, regression = 0.138, p < 0.039) and the effectiveness of treatment was found. No statistical significance between the assessment of the effectiveness of ablation of arrhythmias and the location of the substrate were found but there was no statistical difference between the analyzed parameters and the technical and clinical effectiveness of ablation in the method of localization of arrythmia. The highest percentage of ablation failures in follow-up concerned the technique Carto alone (34%), the most effective was combined techniques adding Pace mapping plus Carto (76% succes rate long after ablation).

CONCLUSIONS: To find substrate of arrhythmia to ablate operator should be guided by stimulation mapping and electroanatomical map in order to achieve distant effect of operation. The only significant parameter correlating with the distant ablation efficacy was the mean temperature of the ablation. While using Carto to ablate arrythmia most important role is played by the precise location of the arrhythmia substrate rather than increasing the temperature during ablation.