Einleitung. Kammertachykardien. Ventrikuläre Tachykardien S.H.E. Idiopathic Katheterablation bei Kammertachykardien

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1 Katheterablation bei Kammertachykardien Ist die Katheterablation als Primärtherapie überzeugend? Einleitung Kammertachykardien Arash Arya Herzzentrum Universität Leipzig VT VES > Ventrikuläre Tachykardien Idiopathic S.H.E. The phen omen on Gallavardin characte rized by short and frequent burd en of outflow tract tachycardia with the behavior of warming up and cooling down which belongs to triggered activity. (Courtesy from Dr. Jacob Atié, Cardioritmo group, Rio de Janeiro) 1

2 I II III avr avl avf V1 V2 V3 V4 V5 V6 Arya et al. Pediatric Cardiology 2007 Arya et al. Pediatric Cardiology 2007 Überblick Primary Prevention ICD Patients with Structural Heart Disease ICD Secondary Prevention CXR, 3 months after RFA 2

3 J Am Coll Cardiol 2015;65: Analysis of 2061 pa tients wi th SHD refer red forcathete rabla tion ofscarrelated VT fro m 12 international centers was performed. hazard ratio 6.9 (95% CI ) One-year free dom fr om VT was 70% (72% in ICMP and68% innicmp ). Fifty-seven patie nts (3%) und erwen t cardiac transpla ntati on, an d 216 (10%) died during follow-up. Heart Rhythm, Vol 12, No 9, September 2015 Weinvestigated 300 patients after CA of sustained VT. CA wasperformed within30days af ter thefirst documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2),and >1 year af ter thefirst VToccurrence in 141 (47%) patients (group3). CA of scar-related VT performed within 30 days af ter the first do cu ment ed VT was safe and associated with better acutesuccess. At 2 years of follow-up,the VT-free survival after early CA was significantly higher. VT Mapping Circ Arrhythm Electrophysiol. 2014;7:

4 Epicardial: -80 ms LV: -55 ms Inferior View Activation Map Substrate Map Inferior View Ventrikuläre Extrasystole 4

5 LVOT Transseptal Approach RAO LAO 35-year-old male patientwith idiopathic RVOT who underwentsuccessfulcatheter ablationdue to symptomaticand drug refractory PVC. On the left and right extremities areshownthe 12-lea d-ecg spontaneous and the Pacemap (s ti mu l us artifact marked) morphologies on the successful site of ablation, respec tively.on the middle-top, the colour-coded ac ti v a ti on map of the RVOT showing the PVC earliest activity (red colour) and the tagged points: in white the best Pacemap and in yellow the His -bundle. On the middle inferior, the fluoros copic views showing the successful siteof ablation. RVOT Right ventricularoutflow tract; PVC Premature ventricularcontraction. Wie häufig ist TICMP? TICMP and Ventricular Arrhythmias Yokok awa and colleagues studied 241 p atients with frequent PVCs who were referred for catheter ablation. 180 patients (75%) experienced symptoms. Left ventricular dysfunction was present in 76 (32 %) patients. Symptom dur ation, the abs enc e of symptoms, and the PVC burden were independent predictors of impaired LV function. Heart Rhythm Jan;9(1):92-5. In the Atherosclerosis Risk in Communities (ARIC) study, association of frequent PVCs with HF incidence in a population based cohort, free of HF and coronary heart disease at baseline, was studied.* Over a follow-up period of 15 years, the incidence of HF in subjects with 1 PVC on a 2 min ECG rhythm strip was significantly higher than in those with no PVCs (HR 1.71, after adjusting for different variables.* * Agarwal SK, Si mp so n Jr RJ, Rautaharju P, et al. Rel ati o n of ven tricu l ar prematu re co mp l exes to h eart fai l u re (fro m th e A th ero scl ero si s Ri sk I n Communities [ARIC] study). Am J Cardiol ; 10 9(1 ): Valvular Ventricular Arrhythmias A 25 y/o / EF/mod. MR /PVCs (~20000/day) LVEDd: 63 mm EF (MRT): 32% Holter EC G studi es reported on pr em ature ventricular beats (PVB) in up to 90% of patients with Heart Failure. In a recent report of 45 patients with frequent PVCs (d efined as >10% [>2-3 % in CRT pati ents] PVC burden), cardiomyopathy developed in 38% of the cases. In this study, patients who developed cardiomyopathy had a broader PVC-QRS complex (> 150 ms) and a broa der sinus rhythm QRS duration. 5

6 MV LCC PVC from MA PVC from LCC RVOT LCC Inferior View RAO LAO RAO LAO Zusammenfassung Die Katheterablation spielt eine wichtige Rolle in der Behandlung von Patienten mit Kammertachykardien und sollte als Therapie der ersten Wahl betrachtet werden. 6