7. Resultados y discusión
7.1. Resultados variables sociodemográficas
ILVT is effectively treated by RF ablation. The presence of diastolic potentials and the pre-Purkinje potentials provide reliable guidance to ablation sites in the LV for
ILVT.49,50The earliest Purkinje potential (with or without the concomitant use of
diastolic potentials) may be superior for selection of the target site of RF ablation
in patients with ILVT51 (Figure 11.9). Non-contact mapping has also been used to
ablate ILVT.52,53 The long-term success of ILVT ablation varied from 83 to 100% in
a small series of followed-up patients.54,55Radiofrequency ablation is safe and
effective for patients with ILVT. Most patients remain free of recurrences at long- term follow-up.
REFERENCES
1. Nakagawa M, Takahashi N, Nobe S et al. Gender differences in various types of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol 2002; 13(7): 633–8.
2. Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing Clin Electrophysiol 1996; 19(12 Pt 1): 2120–37.
3. Lerman BB, Stein K, Engelstein ED et al. Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 1995; 92(3): 421–9.
4. Palileo EV, Ashley WW, Swiryn S et al. Exercise provocable right ventricular outflow tract tachycardia. Am Heart J 1982; 104(2 Pt 1): 185–93.
5. Lerman BB, Belardinelli L, West GA, Berne RM, DiMarco JP. Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity. Circulation 1986; 74: 270–80.
6. Buxton AE, Waxman HL, Marchlinski FE et al. Right ventricular tachycardia: clinical and elec- trophysiologic characteristics. Circulation 1983; 68(5): 917–27.
(a) (b) (c)
7. Rahilly GT, Prystowsky EN, Zipes DP et al. Clinical and electrophysiologic findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardio- gram. Am J Cardiol 1982; 50(3): 459–68.
8. Holt PM, Wainwright RJ, Curry PV. Right ventricular outflow tract tachycardias in patients without apparent structural heart disease. Int J Cardiol 1986; 10(2): 99–110.
9. Hayashi H, Fujiki A, Tani M et al. Role of sympathovagal balance in the initiation of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Pacing Clin Electrophysiol 1997; 20(10 Pt 1): 2371–7.
10. Nakagawa M, Ooie T, Hara M et al. Dynamics of T-U wave in patients with idiopathic ven- tricular tachycardia originating from the right ventricular outflow tract. Pacing Clin Electrophysiol 2004; 27(2): 148–55.
11. Schafers M, Lerch H, Wichter T et al. Cardiac sympathetic innervation in patients with idio- pathic right ventricular outflow tract tachycardia. J Am Coll Cardiol 1998; 32(1): 181–6. 12. Lerman BB, Dong B, Stein KM et al. Right ventricular outflow tract tachycardia due to a
somatic cell mutation in G protein subunit alpha i2. J Clin Invest 1998; 101(12): 2862–8. 13. Cole CR, Marrouche NF, Natale A. Evaluation and management of ventricular outflow tract
tachycardias. Card Electrophysiol Rev 2002; 6(4): 442–7.
14. Tada H, Ito S, Naito S et al. Prevalence and electrocardiographic characteristics of idiopathic ventricular arrhythmia originating in the free wall of the right ventricular outflow tract. Circ J 2004; 68(10): 909–14.
15. Ito S, Tada H, Naito S et al. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 2003; 14(12): 1280–6.
16. Hachiya H, Aonuma K, Yamauchi Y et al. Electrocardiographic characteristics of left ventric- ular outflow tract tachycardia. Pacing Clin Electrophysiol 2000; (11 Pt 2): 1930–4. 17. Ouyang F, Fotuhi P, Ho SY et al. Repetitive monomorphic ventricular tachycardia originating
from the aortic sinus cusp: electrocardiographic characterization for guiding catheter abla- tion. J Am Coll Cardiol 2002; 39(3): 500–8.
18. Molinari G, Sardanelli F, Zandrino F et al. Adipose replacement and wall motion abnormali- ties in right ventricle arrhythmias: evaluation by MR imaging. Retrospective evaluation on 124 patients. Int J Card Imaging 2000; 16(2): 105–15.
19. Globits S, Kreiner G, Frank H et al. Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia. Circulation 1997; 96(8): 2633–40.
20. Carlson MD, White RD, Trohman RG et al. Right ventricular outflow tract ventricular tachy- cardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 1994; 24(3): 720–7.
21. Proclemer A, Basadonna PT, Slavich GA et al. Cardiac magnetic resonance imaging findings in patients with right ventricular outflow tract premature contractions. Eur Heart J 1997; 18(12): 2002–10.
22. Mehta D, Davies MJ, Ward DE, Camm AJ. Ventricular tachycardias of right ventricular origin: markers of subclinical right ventricular disease. Am Heart J 1994; 127(2): 360–6.
23. Tada H, Toide H, Naito S et al. Tissue tracking imaging as a new modality for identifying the origin of idiopathic ventricular arrhythmias. Am J Cardiol 2005; 95(5): 660–4.
24. Yoshida Y, Hirai M, Murakami Y et al. Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: a study of pace mapping using a multielectrode ‘basket’ catheter. Pacing Clin Electrophysiol 1999; 22(12): 1760–8. 25. Pruszkowska-Skrzep P, Kalarus Z, Sredniawa B et al. Effectiveness of radiofrequency catheter
ablation of right ventricular outflow tract tachycardia using the CARTO system. Kardiol Pol 2005; 62(2): 138–44.
26. Lamberti F, Calo’ L, Pandozi C et al. Radiofrequency catheter ablation of idiopathic left ven- tricular outflow tract tachycardia: utility of intracardiac echocardiography. J Cardiovasc Electrophysiol 2001; 12(5): 529–35.
27. Kurzidim K, Schneider HJ, Kuniss M et al. Cryocatheter ablation of right ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 2005; 16(4): 366–9.
28. Tsai CF, Chen SA, Tai CT et al. Idiopathic monomorphic ventricular tachycardia: clinical outcome, electrophysiologic characteristics and long-term results of catheter ablation. Int J Cardiol 1997; 62(2): 143–50.
29. Rodriguez LM, Smeets JL, Timmermans C, Wellens H. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol 1997; 79(3): 309–14. 30. Kanagaratnam L, Tomassoni G, Schweikert R et al. Ventricular tachycardias arising from the
aortic sinus of Valsalva: an under-recognized variant of left outflow tract ventricular tachy- cardia. J Am Coll Cardiol 2001; 37(5): 1408–14.
31. Tada H, Nogami A, Naito S et al. Left ventricular epicardial outflow tract tachycardia: a new distinct subgroup of outflow tract tachycardia. Jpn Circ J 2001; 65(8): 723–30.
32. Villacastin J, Perez Castellano N, Moreno J et al. Percutaneous epicardial radiofrequency ablation of idiopathic ventricular tachycardia. Rev Esp Cardiol 2005; 58(1): 100–4. 33. Hachiya H, Aonuma K, Yamauchi Y et al. How to diagnose, locate, and ablate coronary cusp
ventricular tachycardia. J Cardiovasc Electrophysiol 2002; 13(6): 551–6.
34. Klein LS, Miles WM, Hackett FK, Zipes DP. Catheter ablation of ventricular tachycardia using radiofrequency techniques in patients without structural heart disease. Herz 1992; 17(3): 179–89.
35. Tada H, Ito S, Naito S et al. Idiopathic ventricular arrhythmia arising from the mitral annu- lus: a distinct subgroup of idiopathic ventricular arrhythmias. J Am Coll Cardiol 2005; 45(6): 877–86.
36. Kautzner J, Cihak R, Vancura V, Bytesnik J. Coincidence of idiopathic ventricular outflow tract tachycardia and atrioventricular nodal reentrant tachycardia. Europace 2003; 5(3): 215–20. 37. Stevenson WG, Delacretaz E. Radiofrequency catheter ablation of ventricular tachycardia.
Heart 2000; 84(5): 553–9.
38. Belhassen B, Rotmensch HH, Laniado S. Response of recurrent sustained ventricular tachy- cardia to verapamil. Br Heart J 1981; 46: 679–82.
39. Lerman BB, Stein KM, Markowitz SM. Mechanisms of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 1997; 8(5): 571–83.
40. Aiba T, Suyama K, Aihara N et al. The role of Purkinje and pre-Purkinje potentials in the reentrant circuit of verapamil-sensitive idiopathic LV tachycardia. Pacing Clin Electrophysiol 2001; 24(3): 333–44.
41. Thakur RK, Klein GJ, Sivaram CA et al. Anatomic substrate for idiopathic left ventricular tachycardia. Circulation 1996; 93(3): 497–501.
42. Maruyama M, Tadera T, Miyamoto S, Ino T. Demonstration of the reentrant circuit of vera- pamil-sensitive idiopathic left ventricular tachycardia: direct evidence for macroreentry as the underlying mechanism. J Cardiovasc Electrophysiol 2001; 12(8): 968–72.
43. Kuo JY, Tai CT, Chiang CE et al. Is the fascicle of left bundle branch involved in the reentrant circuit of verapamil-sensitive idiopathic left ventricular tachycardia? Pacing Clin Electrophysiol 2003; 26(10): 1986–92.
44. Damle RS, Landers M, Kelly PA, Reiter MJ, Mann DE. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia originating in the left anterior fascicle. Pacing Clin Electrophysiol 1998; 21(5): 1155–8.
45. Lee KL, Lauer MR, Young C et al. Spectrum of electrophysiologic and electropharmacologic characteristics of verapamil-sensitive ventricular tachycardia in patients without structural heart disease. Am J Cardiol 1996; 77(11): 967–73.
46. Lerman BB, Stein KM, Markowitz SM, Mittal S, Slotwiner D. Catecholamine facilitated reen- trant ventricular tachycardia: uncoupling of adenosine’s antiadrenergic effects. J Cardiovasc Electrophysiol 1999; 10(1): 17–26.
47. Nogami A. Idiopathic left ventricular tachycardia: assessment and treatment. Card Electrophysiol Rev 2002; 6(4): 448–57.
48. Yeh YH, Lin KH, Luqman N, Sung RJ, Kuo CT. Pleomorphic ventricular tachycardia: an uncommon presentation in idiopathic left ventricular tachycardia. Pacing Clin Electrophysiol 2005; 28(4): 343–5.
49. Sasano T, Satake S, Azegami K et al. Diastolic potentials observed in idiopathic left ventricular tachycardia. Jpn Circ J 1999; 63(12): 917–23.
50. Nogami A, Naito S, Tada H et al. Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Am Coll Cardiol 2000; 36(3): 811–23.
51. Arya A, Haghjoo M, Emkanjoo Z et al. Comparison of presystolic Purkinje and late diastolic potentials for selection of ablation site in idiopathic verapamil sensitive left ventricular tachy- cardia. J Interv Card Electrophysiol 2004; 11(2): 135–41.
52. Sra J, Bhatia A, Krum D, Akhtar M. Endocardial noncontact activation mapping of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 2000; 11(12): 1409–12.
53. Betts TR, Roberts PR, Allen SA, Morgan JM. Radiofrequency ablation of idiopathic left ven- tricular tachycardia at the site of earliest activation as determined by noncontact mapping. J Cardiovasc Electrophysiol 2000; 11(10): 1094–101.
54. Topilski I, Glick A, Belhassen B. Idiopathic left ventricular tachycardia with a right bundle branch block morphology and left axis deviation (‘Belhassen type’): results of radiofrequency ablation in 18 patients. Isr Med Assoc J 2004; 6(4): 195–200.
55. Zardini M, Thakur RK, Klein GJ, Yee R. Catheter ablation of idiopathic left ventricular tachycardia. Pacing Clin Electrophysiol 1995; 18(6): 1255–65.