ОЦЕНКА ЭФФЕКТИВНОСТИ АБЛАЦИИ ЖЕЛУДОЧКОВЫХ ТАХИАРИТМИЙ ИЗ ПРИТОЧНОГО ОТДЕЛА ПРАВОГО ЖЕЛУДОЧКА У ПАЦИЕНТОВ БЕЗ СТРУКТУРНОЙ ПАТОЛОГИИ СЕРДЦА

To assess effectiveness and safety of radiofrequency ablation (RFA) of ventricular tachyarrhythmia (VTA) located in the right ventricular inflow tract, 32 patients aged 39.7±19.1 years were examined and treated. The number of ventricular premature contractions (PVC) detected was 17,642±13,475; sustained ventricular tachycardia (VT) was documented in 7 patients (21.9%); implantable cardioverters-defibrillators (ICD) were implanted in 4 patients (12.5%). Antiarrhythmic therapy was ineffective in all patients. RFA was performed using the NaviStar ThermoCool irrigated electrode, with the irrigation velocity of 17 ml/min, maximal power or 40 W, maximal temperature of 43°C, and the duration of each application of 40 60 s. Freedom of VPC/VT throughout the follow-up period after single or repetitive ablations was the study primary endpoint. The secondary study endpoints were as follows: complications of the procedure and the number of VPC. In 20 patients (62.5%), VTA originated from the tricuspid valve area and, in 12 patients (37.5%), from the basal part of the right ventricle. In 29 patients (90.6%), the only morphology of PVC/VT was revealed; 3 patients (9.4%) had polymorphous PVCs. The number of points for 3D reconstruction of the right ventricular inflow tract endocardial surface was 37±11. The normal endocardial voltage in the right ventricular inflow tract was revealed in all patients. The number of radiofrequency applications was 10.6±3.2, with the fluoroscopy exposure of 6.6±2.8 min and the procedure duration of 59.7±10.2 min. In 2 patients (6.2%), RFA was not performed because of parahisian location of PVs and a high risk of development of complete atrio-ventricular block. In one patient (3.1%) with the PVC/VT location in the free wall, the RFA in the right ventricle was ineffective. Thus, the overall effectiveness of RFA was 93.8% (30 patients). The late effectiveness of the procedure after the single ablation was 87.5%, after repetitive procedures, 93.8%. Thus, RFA of VTA originating from the right ventricular inflow tract is a highly effective and safe technique of treatment which permits one to maintain the sinus rhythm during the entire follow-up period.