Predictores electrocardiográficos de éxito agudo en la ablación de las arritmias ventriculares del tracto de salida de ventrículo derecho

Abstract

Idiopathic outflow tract ventricular arrhythmias are common and usually have a benign course. However, the limited usefulness of antiarrhythmic drugs to control them, as well as the risk of developing secondary cardiomyopathy, have made radiofrequency ablation the treatment of choice. Most idiopathic ventricular arrhythmias originate in the right ventricular outflow tract, with right ablation being a safe procedure, with acute success rates ranging from 83% to 100%. Less frequently, they can originate in the left ventricular outflow tract and adjacent positions, generally being more complex ablation procedures, with lower success rates and higher risks. The anatomical proximity of all these regions makes the electrocardiographic diagnosis more challenging. Precisely predicting the origin of the arrhythmia is essential to plan the procedure and decide the anatomical access (venous in case of origin in RVOT, arterial if the origin is suspected in LVOT), as well as to estimate its risks and adequate information to the patient. OBJECTIVES: The main objective of the study is to establish a predictive model of independent electrocardiographic parameters to obtain acute success of radiofrequency ablation performed from positions of the right ventricular outflow tract in patients with focal ventricular arrhythmias with a predominantly negative QRS pattern in the first two precordial. As secondary objectives, we propose an external validation of the previously described predictive electrocardiographic algorithms for our overall study sample, as well as specifically analysing their behaviour in arrhythmias with transition in V3 (electrocardiographic transition with greater overlap between the right and left origin). On the other hand, a descriptive study of patients with cardiomyopathy due to ventricular extrasystoles was carried out in order to propose possible clinical or electrocardiographic predictors for their identification...