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Indicaciones para la ablación 
de extrasistolia ventricular 
Sergio L. Pinski 
Cleveland Clinic Florida 
Weston, Florida, ...
Indicaciones para la ablacion de extrasistolia 
ventricular 
• Síntomas severos 
• Disfunción ventricular (con o sin enfer...
Bradysphygmia as cause of symptoms 
Lu et al. Am J Cardiol 2012; 110:852
Stec et al. Chest 2009;135:1535
Increase in wedge pressure after PVCs 
Kuroki et al. Eur J Heart Fail 2012;14:1112
Increase in wedge pressure after PVCs 
Kuroki et al. Eur J Heart Fail 2012;14:1112
Increase in wedge pressure after PVCs 
Kuroki et al. Eur J Heart Fail 2012;14:1112
Increase in wedge pressure after PVCs 
Kuroki et al. Eur J Heart Fail 2012;14:1112
Figure 2 
Reduction in the frequency PVCs after treatment 
with antiarrhythmic drugs or RFA 
Zhong et al. Heart Rhythm 201...
PVCs with nocturnal predominance
Factores de riesgo para la cardiomiopatía 
inducida por extrasístoles 
• Carga ectópica (al menos 10-25% del # total de 
l...
4-year effect of PVCs on LV function 
Cha et al. Circ Arrhythm Electrophysiol 2012;5:229
Burden of PVCs and LV dysfunction 
Baman et al. Heart Rhythm 2010; 7:865
ROC curve for # of PVCs in 12-lead ECG as a 
predictor oh high-burden PVC in Holter 
Yang et al. PACE 2014;
ROC curve of PVC width as predictor of 
reversible PVC-induced cardiomyopathy 
150 ms 
Yokokawa et al. Heart Rhythm 2012; ...
Effect of successful ablation on LVEF 
Bogun et al. Heart Rhythm 2007; 4:863
Meta-analysis of PVC ablation in pts with 
baseline LV dysfunction 
Zang et al. Heart 2014; 100:787
Similar improvement in pts with and 
without structural heart disease 
Penela et al. JACC 2013; 62:1195
Effect of successful ablation on LVEF in post MI 
patients with LV dysfunction 
Sarrazain et al. Heart Rhythm 2009; 6:1543
Substrate of PVCs in pts with old MI 
Bogun et al. Heart Rhythm 2008;5:367
Figure 2 
Changes in PVC frequency LVEF after 
treatment by PVC origin groups 
Zhong et al. Heart Rhythm 2014; 11:187
Suppression of ventricular ectopy with 
amiodarone does not improve survival in CHF 
Singh et al. NEJM 1995; 333:77
Non responder 
CAD, LVEF 30%, no MI, Holter with 20% ectopic beats 
(1078/hour)
LV dysfunction, LBBB and RVOT bigeminy: 
what to do?
ECG score to distinguish idiopathic RVOT 
from ARVD 
Hoffmayer et al. Heart Rhythm 2013; 10:477
Cha et al. Circ Arrhythm Electrophysiol 2012;5:229
RFA of PVCs improves efficacy of CRT in 
non-responders 
Lakkireddy et al. JACC 2012; 60:1531
Ventricular Bigeminy in a Professional Ice Hockey Player 
ECG Holter Stress test 
Pre 
Post
3-D voltage mapping of RVOT arrhythmias 
Corrado et al. JACC 2008; 51-731
Concealed cardiomyopathies in competitive 
athletes with ventricular arrhythmias and an 
apparently normal heart 
Dello Ru...
Ablación de PVCs “gatillo”: sustratos 
y sitios de origen 
• FV idiopática 
• QT largo 
• Brugada 
• Displasia de VD 
• IA...
Figure 3 
Number of VF episodes in 3 months before 
and after ablation in 29 patients undergoing 
acutely successful ablat...
Sadek et al. Heart Rhythm 2014; in press
Figure 4 
Van Herendael et al. Heart Rhythm 2014; 11:566
Figure 5 
Van Herendael et al. Heart Rhythm 2014; 11:566
Conclusiones 
• La ablación de ectopia ventricular es un procedimiento 
clínicaemente útil y establecido 
• En muchos labo...
Indicaciones para la ablación de extrasistolia ventricular
Indicaciones para la ablación de extrasistolia ventricular
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Indicaciones para la ablación de extrasistolia ventricular

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Slide set presented in Buenos Aires, October 5, 2015 at the Argentine Congress of Cardiology

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Indicaciones para la ablación de extrasistolia ventricular

  1. 1. Indicaciones para la ablación de extrasistolia ventricular Sergio L. Pinski Cleveland Clinic Florida Weston, Florida, USA
  2. 2. Indicaciones para la ablacion de extrasistolia ventricular • Síntomas severos • Disfunción ventricular (con o sin enfermedad cardíaca estructural) • Facilitar la terapia de resincronización cardíaca • Ciertas profesiones (atletas profesionales, pilotos comerciales) • Gatillos de fibrilación ventricular recurrente
  3. 3. Bradysphygmia as cause of symptoms Lu et al. Am J Cardiol 2012; 110:852
  4. 4. Stec et al. Chest 2009;135:1535
  5. 5. Increase in wedge pressure after PVCs Kuroki et al. Eur J Heart Fail 2012;14:1112
  6. 6. Increase in wedge pressure after PVCs Kuroki et al. Eur J Heart Fail 2012;14:1112
  7. 7. Increase in wedge pressure after PVCs Kuroki et al. Eur J Heart Fail 2012;14:1112
  8. 8. Increase in wedge pressure after PVCs Kuroki et al. Eur J Heart Fail 2012;14:1112
  9. 9. Figure 2 Reduction in the frequency PVCs after treatment with antiarrhythmic drugs or RFA Zhong et al. Heart Rhythm 2014; 11:187
  10. 10. PVCs with nocturnal predominance
  11. 11. Factores de riesgo para la cardiomiopatía inducida por extrasístoles • Carga ectópica (al menos 10-25% del # total de latidos) • Duración de los síntomas • Intevalo de acoplamiento corto • Extrasístoles interpoladas • Extrasístoles más anchas • Conducción retrógrada • Origen epicárdico • VD> VI ?
  12. 12. 4-year effect of PVCs on LV function Cha et al. Circ Arrhythm Electrophysiol 2012;5:229
  13. 13. Burden of PVCs and LV dysfunction Baman et al. Heart Rhythm 2010; 7:865
  14. 14. ROC curve for # of PVCs in 12-lead ECG as a predictor oh high-burden PVC in Holter Yang et al. PACE 2014;
  15. 15. ROC curve of PVC width as predictor of reversible PVC-induced cardiomyopathy 150 ms Yokokawa et al. Heart Rhythm 2012; 9:1460
  16. 16. Effect of successful ablation on LVEF Bogun et al. Heart Rhythm 2007; 4:863
  17. 17. Meta-analysis of PVC ablation in pts with baseline LV dysfunction Zang et al. Heart 2014; 100:787
  18. 18. Similar improvement in pts with and without structural heart disease Penela et al. JACC 2013; 62:1195
  19. 19. Effect of successful ablation on LVEF in post MI patients with LV dysfunction Sarrazain et al. Heart Rhythm 2009; 6:1543
  20. 20. Substrate of PVCs in pts with old MI Bogun et al. Heart Rhythm 2008;5:367
  21. 21. Figure 2 Changes in PVC frequency LVEF after treatment by PVC origin groups Zhong et al. Heart Rhythm 2014; 11:187
  22. 22. Suppression of ventricular ectopy with amiodarone does not improve survival in CHF Singh et al. NEJM 1995; 333:77
  23. 23. Non responder CAD, LVEF 30%, no MI, Holter with 20% ectopic beats (1078/hour)
  24. 24. LV dysfunction, LBBB and RVOT bigeminy: what to do?
  25. 25. ECG score to distinguish idiopathic RVOT from ARVD Hoffmayer et al. Heart Rhythm 2013; 10:477
  26. 26. Cha et al. Circ Arrhythm Electrophysiol 2012;5:229
  27. 27. RFA of PVCs improves efficacy of CRT in non-responders Lakkireddy et al. JACC 2012; 60:1531
  28. 28. Ventricular Bigeminy in a Professional Ice Hockey Player ECG Holter Stress test Pre Post
  29. 29. 3-D voltage mapping of RVOT arrhythmias Corrado et al. JACC 2008; 51-731
  30. 30. Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart Dello Russo et al. Heart Rhythm 2011; 8:1915
  31. 31. Ablación de PVCs “gatillo”: sustratos y sitios de origen • FV idiopática • QT largo • Brugada • Displasia de VD • IAM • Miocardiopatías • Tracto de salida VD • Tracto de salida VI • Banda moderadora • Músculos papilares • Sistema de Purkinje • Cicatriz • Epicardio
  32. 32. Figure 3 Number of VF episodes in 3 months before and after ablation in 29 patients undergoing acutely successful ablation of PVC triggers Van Herendael et al. Heart Rhythm 2014; 11:566
  33. 33. Sadek et al. Heart Rhythm 2014; in press
  34. 34. Figure 4 Van Herendael et al. Heart Rhythm 2014; 11:566
  35. 35. Figure 5 Van Herendael et al. Heart Rhythm 2014; 11:566
  36. 36. Conclusiones • La ablación de ectopia ventricular es un procedimiento clínicaemente útil y establecido • En muchos laboratorios, constituye la indicación de ablación más frecuente luego de la fibrilación auricular • En pacientes con cardiomiopatía dilatada presuntamente idiopática, se debe suprimir la arritmia, preferentemente con ablación, y luego re-evaluar antes de considerar el desfibrilador implantable u otros tratatamientos como el transplante • Es necesario un estudio randomizado de ablación de extrasístoles ventriculares my frecuentes en pacientes con disfunción ventricular e infarto de miocardio previo.

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