Ethan R Ellis1, Alexei Shvilkin2, Mark E Josephson2. 1. Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: eellis@bidmc.harvard.edu. 2. Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Ventricular arrhythmias in the absence of structural heart disease are commonly referred to as "idiopathic." Patients with structural heart disease have ventricular arrhythmias with the same mechanisms and sites of origin as idiopathic ventricular arrhythmias, but the prevalence of such arrhythmias is not well defined. OBJECTIVES: To identify the prevalence of nonreentrant ventricular arrhythmias unrelated to abnormal myocardial substrate in patients with structural heart disease and to compare these arrhythmias to ventricular arrhythmias in patients with structurally normal hearts. METHODS: Of 249 consecutive patients referred for ablation of ventricular arrhythmias, 97 (39%) patients had nonreentrant arrhythmias unrelated to underlying structural heart disease. Fifty-five (57%) patients had structurally normal hearts, and 42 (43%) had underlying structural heart disease. RESULTS: Compared with patients with structurally normal hearts, patients with structural heart disease were more likely to have nonreentrant ventricular arrhythmias unrelated to underlying abnormal myocardial substrate originating from the aortic cusps and left ventricular outflow tract whereas patients without structural heart disease more often had arrhythmias originating from the right ventricular outflow tract. There was a significant increase in the average left ventricular ejection fraction after ablation in patients with structural heart disease. CONCLUSION: Nonreentrant ventricular arrhythmias unrelated to abnormal myocardial substrate are common in patients with structural heart disease, and sites of origin differ from those seen in patients with structurally normal hearts. When managing structural heart disease in patients with ventricular arrhythmias, a focus on arrhythmia mechanism, origin, and relationship to underlying myocardial substrate may have important implications for future treatment options and patient outcomes.
BACKGROUND:Ventricular arrhythmias in the absence of structural heart disease are commonly referred to as "idiopathic." Patients with structural heart disease have ventricular arrhythmias with the same mechanisms and sites of origin as idiopathic ventricular arrhythmias, but the prevalence of such arrhythmias is not well defined. OBJECTIVES: To identify the prevalence of nonreentrant ventricular arrhythmias unrelated to abnormal myocardial substrate in patients with structural heart disease and to compare these arrhythmias to ventricular arrhythmias in patients with structurally normal hearts. METHODS: Of 249 consecutive patients referred for ablation of ventricular arrhythmias, 97 (39%) patients had nonreentrant arrhythmias unrelated to underlying structural heart disease. Fifty-five (57%) patients had structurally normal hearts, and 42 (43%) had underlying structural heart disease. RESULTS: Compared with patients with structurally normal hearts, patients with structural heart disease were more likely to have nonreentrant ventricular arrhythmias unrelated to underlying abnormal myocardial substrate originating from the aortic cusps and left ventricular outflow tract whereas patients without structural heart disease more often had arrhythmias originating from the right ventricular outflow tract. There was a significant increase in the average left ventricular ejection fraction after ablation in patients with structural heart disease. CONCLUSION: Nonreentrant ventricular arrhythmias unrelated to abnormal myocardial substrate are common in patients with structural heart disease, and sites of origin differ from those seen in patients with structurally normal hearts. When managing structural heart disease in patients with ventricular arrhythmias, a focus on arrhythmia mechanism, origin, and relationship to underlying myocardial substrate may have important implications for future treatment options and patient outcomes.
Authors: Michael Fiek; Thomas Remp; Martin Fleckenstein; Tilman Pohl; Michael Deiss; Christopher Reithmann Journal: J Interv Card Electrophysiol Date: 2015-01-27 Impact factor: 1.900
Authors: Ruben Schleberger; Jan Riess; Anika Brauer; Hans O Pinnschmidt; Laura Rottner; Fabian Moser; Julia Moser; Shinwan Kany; Ilaria My; Marc D Lemoine; Bruno Reissmann; Christian Meyer; Andreas Metzner; Feifan Ouyang; Paulus Kirchhof; Andreas Rillig Journal: Front Cardiovasc Med Date: 2022-05-25