This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.05.077v1 46/7/1288    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Noda, T. Articles by Kamakura, S. Search for Related Content PubMed PubMed Citation Articles by Noda, T. Articles by Kamakura, S.

CLINICAL RESEARCH: HEART RHYTHM DISORDER

Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract

Takashi Noda, MD, PhD^_*, Wataru Shimizu, MD, PhD^_*,_*, Atsushi Taguchi, MD^_*, Takeshi Aiba, MD, PhD, Kazuhiro Satomi, MD^_*, Kazuhiro Suyama, MD, PhD^_*, Takashi Kurita, MD, PhD^_*, Naohiko Aihara, MD^_* and Shiro Kamakura, MD, PhD^_*

^_* Division of Cardiology, Department of Internal Medicine, Research Institute, National Cardiovascular Center, Suita, Japan
Department of Cardiovascular Dynamics, Research Institute, National Cardiovascular Center, Suita, Japan

Manuscript received February 9, 2005; revised manuscript received April 28, 2005, accepted May 9, 2005.

^_* Reprint requests and correspondence: Dr. Wataru Shimizu, Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan (Email: wshimizu{at}hsp.ncvc.go.jp).

Presented in part at Heart Rhythm 2004, San Francisco, California, May 19–22, 2004, and published in abstract form (Heart Rhythm 2004;1[IS]:S269).

OBJECTIVES: The aim of this study was to assess the clinical characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for idiopathic ventricular fibrillation (VF) and/or polymorphic ventricular tachycardia initiated by ventricular extrasystoles originating from the right ventricular outflow tract (RVOT).

BACKGROUND: Ventricular fibrillation and/or polymorphic ventricular tachycardia are occasionally initiated by ventricular extrasystoles originating from the RVOT in patients without structural heart disease.

METHODS: Among 101 patients without structural heart disease in whom RFCA was conducted for idiopathic ventricular tachyarrhythmias arising from the RVOT, we examined the clinical characteristics and the efficacy of RFCA in 16 patients with spontaneous VF and/or polymorphic ventricular tachycardia initiated by the ventricular extrasystoles originating from the RVOT.

RESULTS: Among 16 patients, spontaneous episodes of VF were documented in 5 patients, and 11 patients had prior episodes of syncope. Holter recordings showed frequent isolated ventricular extrasystoles with the same morphology as that of initiating ventricular extrasystoles, and non-sustained polymorphic ventricular tachycardia with short cycle length (mean of 245 ± 28 ms) in all 16 patients. Radiofrequency catheter ablation by targeting the initiating ventricular extrasystoles eliminated episodes of syncope, VF, and cardiac arrest in all patients during follow-up periods of 54 ± 39 months.

CONCLUSIONS: Our data suggest that the malignant entity of idiopathic VF and/or polymorphic ventricular tachycardia was occasionally present in patients with idiopathic ventricular arrhythmias arising from the RVOT. Radiofrequency catheter ablation was effective as a treatment option for this entity.

Abbreviations and Acronyms   ECG = electrocardiogram   EPS = electrophysiologic study   ICD = implantable cardioverter-defibrillator   PVC = premature ventricular contraction   PVT = polymorphic ventricular tachycardia   RFCA = radiofrequency catheter ablation   RVOT = right ventricular outflow tract   SAECG = signal-averaged electrocardiogram   VE = ventricular extrasystoles   VF = ventricular fibrillation

This article has been cited by other articles:

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]

				G A. Ng Treating patients with ventricular ectopic beats. Heart, November 1, 2006; 92(11): 1707 - 1712. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas Highlights of the Year in JACC 2005 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202. [Full Text] [PDF]

				S. Viskin and C. Antzelevitch The Cardiologists' Worst Nightmare: Sudden Death From "Benign" Ventricular Arrhythmias J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1295 - 1297. [Full Text] [PDF]