Koroner kusp kaynaklı prematüre ventriküler komplekslerin kateter ablasyonu sonrası ortaya çıkan aort kapak yetmezliği sıklığı

Yıl 2023, , 229 - 233, 28.06.2023

İsmet Zengin Selcuk Kanat

https://doi.org/10.47582/jompac.1308239

Öz

Amaç: Koroner tüberküllerden köken alan prematür ventriküler kompleksler (PVC'ler) tüm PVC'lerin %25'ini oluşturur. İlaç tedavisine rağmen semptomatik olan, yüksek PVC yükü ve kardiyak fonksiyon bozukluğu olan olgularda radyofrekans kateter ablasyonu (RFA) altın standart tedavi seçeneğidir. Aortik cusp PVC'lerin RFA'sının aort kapak yetersizliği (AR) üzerindeki etkisi hakkında çelişkili sonuçlar vardır.
Yöntemler: Bu kesitsel çalışmaya, belirtilen endikasyonlar dahilinde aort doruk bölgesine RFA uygulanan 54 hasta dahil edildi. Bazal ekokardiyografi başlangıçta ve aortik tüberkül PVC'lerin radyofrekans kateter ablasyonundan 3 ay sonra yapıldı. AR'de 1 dereceden fazla artış anlamlı kabul edildi.
Bulgular: Hastaların yaş ortalaması 44,59 (±11,96), erkek cinsiyet oranı %42,59 (n=23) idi. 24 saatlik ritim holter monitörizasyonunda ortalama VES yükü %21,5 (9-33) olup, bunun %12,9'u (n=7) RCC, %59,3'ü (n=32) LCC ve %27,8'i (n=15) idi. RCC-LCC bağlantısı. Toplam işlem süresi 136,9±33,2 dakika, RF ablasyon süresi 14,9±11,4 dakika idi. Ablasyon öncesi ve sonrası parametreler karşılaştırıldığında, işlem sonrası sol ventrikül ejeksiyon fraksiyonu (SVEF) işlem öncesine göre daha yüksek bulundu (p<0,001). İşlem öncesi ve sonrası AR derecesinde istatistiksel olarak anlamlı artış yoktu (p<0.05).
Sonuç: Aort tüberkül bölgesindeki PVC'ler için RFA yapılan hastalarda işleme bağlı komplikasyon olarak AR derecesinde artış olmadı ve anlamlı AR saptanmadı. Bu nedenle aortik tüberkül bölgesindeki VES ablasyonlarının AR gelişimi için güvenli olduğu sonucuna varılabilir.

Anahtar Kelimeler

Prematüre ventriküler kompleksler, radyofrekans ablasyonu, aort doruğu, aort yetersizliği

Aortic valve regurgitation frequency following catheter ablation of premature ventricular complexes originating from coronary cusps

Öz

Aims: There are conflicting results about the effect of radiofrequency catheter ablation (RFA) of aortic cusp premature ventricular complexes (PVCs) on aortic valve regurgitation (AR). We aimed to investigate the effect of aortic valve function and integrity of RFA of coronary cusp PVCs.
Methods: This cross-sectional study included 54 patients who underwent RFA of the aortic cusp region within the specified indications. Basal echocardiography was performed at baseline and 3 months after radiofrequency catheter ablation of aortic cusp PVCs. An increase of more than 1 degree in AR was considered significant.
Results: The mean age of the patients was 44.6±12.0 years and the male gender ratio was 42.6%. On 24-hour rhythm holter monitoring, the mean VES burden was 21.5%, of which 12.9% were right coronary cusp (RCC), 59.3% left coronary cusp (LCC), and 27.8% RCC-LCC junction. Total procedure time was 136.9±33.2 minutes and RFA time was 14.9±11.4 minutes. When pre- and post-ablation parameters were compared, left ventricular ejection fraction was found to be higher after the procedure than before the procedure (p<0.001). There was no statistically significant increase in the degree of AR before and after the procedure (p>0.05).
Conclusion: There was no increase in the degree of AR as a procedure-related complication and no significant AR was determined in patients who underwent RFA for PVCs in the aortic cusp region. Therefore, it can be concluded that VES ablations in the aortic cusp region are safe for the development of AR.

Anahtar Kelimeler

Premature ventricular complexes, radiofrequency ablation, aortic cusp, aortic regurgitation

Kaynakça

• Ahn MS. Current concepts of premature ventricular contractions. J Lifestyle Med. 2013;3(1):26-33.
• Tutuncu A, Yilmaz E. Features of patients with premature ventricular complex ablation: single center case series. Eur Res J. 2021;7(2):159-169. doi:10.18621/eurj.775245
• Minich LL, Snider AR, Dick M 2nd. Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections. Am J Cardiol. 1992;70(1):116-117. doi: 10.1016/0002-9149(92)91404-r
• Edward JA, Zipse MM, Tompkins C, et al. Follow-up after catheter ablation of papillary muscles and valve cusps. JACC Clin Electrophysiol. 2019;5(10):1185-1196. doi:10.1016/j.jacep.2019.07.004
• Kis Z, Pal M, Szabo Z, Kardos A. Aortic valve rupture due to radiofrequency ablation of left ventricular outflow tract extrasystole. J Cardiovasc Electrophysiol. 2016;27(8):992. doi:10.1111/jce.12959
• Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777-802. doi:10.1016/S0894-7317(03)00335-3
• Huang SK, Bharati S, Graham AR, Lev M, Marcus FI, Odell RC. Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy--a new method of catheter ablation. J Am Coll Cardiol. 1987;9(2):349-358. doi:10.1016/s0735-1097 (87)80388-1
• Huang SK, Bharati S, Lev M, Marcus FI. Electrophysiologic and histologic observations of chronic atrioventricular block induced by closed-chest catheter desiccation with radiofrequency energy. Pacing Clin Electrophysiol. 1987;10(4 Pt 1):805-816. doi: 10.1111/j.1540-8159.1987.tb06037.x
• Shehata E, Abdel-Samie MS, Elkoumy A, Yehia A, Soliman O, Abdelghani M. Aortic regurgitation as a complication of electrophysiologic ablation techniques: a narrative review. Curr Cardiol Rev. 2021;17(6):e051121192738. doi:10.2174/1573403X17666210408093447
• Styczkiewicz K, Ludwik B, Śledź J, et al. Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry). Pol Arch Intern Med. 2019;129(6):399-407. doi:10.20452/pamw.14861
• Hoffmayer KS, Dewland TA, Hsia HH, et al. Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias. Heart Rhythm. 2014;11(7):1117-1121. doi:10.1016/j.hrthm.2014.04.019
• Shinoda Y, Komatsu Y, Sekiguchi Y, Nogami A, Aonuma K, Ieda M. Iatrogenic aortic regurgitation after radiofrequency ablation of idiopathic ventricular arrhythmias originating from the aortic valvular region. Heart Rhythm. 2019;16(8):1189-1195. doi:10.1016/j.hrthm.2019.03.010