New non-invasive markers and results of interventional treatmentof nonischemic ventricular arrhythmias

Authors: Shomakhov R.A., Bockeria L.A., Golukhova E.Z., Makarenko V.N., Gromova O.I., Aleksandrova S.A.

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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For citation: R.A. Shomakhov, L.A. Bockeria, E.Z. Golukhova; New non-invasive markers and results of interventional treatment of nonischemic ventricular arrhythmias; Kreativnaya Kardiologiya. 2016; 10 (1): 54-68 (in Russian)

Keywords: magnetic resonance imaging late gadolinium enhancement ventricular arrhythmias sudden cardiac death

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Objective. The aim of our study was analyze the role of myocardial fibrosis as a marker of arrhythmic events and the results of interventional treatment of nonischemic ventricular arrhythmias.

Material and methods. In our study we included 99 patients with nonischemic ventricular arrhythmias. The mean age of patients was 37,5±15,3 years (53% men). The survey protocol included medical history, physical examination, electrocardiography (ECG), echocardiography, Holter monitoring, treadmill test, cardiac magnetic resonance imaging (MRI) with quantification of left ventricle (LV) myocardial fibrosis, invasive electrophysiologic study, in some cases computed tomography (CT) or coronary angiography. Cardiac MRI performed in 87.9% of cases (n=87), contrast enhanced MRI in 81.8% (n=81). Surgical treatment was performed in 92.9% of patients (n=92): radiofrequency ablation (RFA) in 80.8% (n=80) and implantation of implantable cardioverter defibrillator (ICD) in 12.1% (n=12). 

Results. In patients with LV myocardial fibrosis ≥ 4% significantly higher chance of syncope (OR 8.8) and sustained ventricular tachycardia (VT) (odds ratio (OR) 19.2); it is also significantly higher risk of induction of sustained VT at electrophysiological (EP) study (OR 19.7), implantation of the ICD (OR 14.0) and shocks. Linear and volume parameters of LV and RV (right ventricle) were significantly higher in patients with LV myocardial fibrosis ≥ 4%. The efficiency of RFA was 58.8%, the highest efficiency revealed in patients with right ventricular outflow tract (RVOT) arrhythmias (71.2%). The 3-months follow up showed 80.9% efficiency of the combined treatment (RFA + antiarrhythmic therapy). 

Conclusion. The scar size of LV myocardium, measured by cardiac MRI with late gadolinium enhancement (LGE), is perspective noninvasive marker of major arrhythmic events in patients with nonischemic ventricular arrhythmias. RFA is an effective method of treatment of ventricular arrhythmias, particularly in patients with RVOT arrhythmias.


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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery