Skip to main content
Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 3/2015

01.09.2015 | Ventrikuläre Tachykardien | Schwerpunkt

Ursprungslokalisation bei idiopathischen ventrikulären Extrasystolen und Tachykardien aus dem Ausflusstrakt

verfasst von: Dr. Thomas M. Helms, Dr. Antonio Madaffari, Prof. Dr. J. Christoph Geller, Prof. Dr. Matthias Antz

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Ventrikuläre Extrasystolen (VES) sind häufig und in der Regel ohne strukturelle Herzerkrankung nicht lebensbedrohlich. Sie erfordern jedoch aufgrund der Symptomatik häufig eine Behandlung, entweder medikamentös oder heutzutage überwiegend mittels Katheterablation. Das Oberflächen-EKG ist dabei ein wichtiges Instrument zur Lokalisation des Ursprungsorts und insbesondere der Unterscheidung zwischen rechts- und linksventrikulärem Ursprung.
Literatur
1.
Zurück zum Zitat Gottlieb SH, Ouyang P, Gottlieb SO (1988) Death after acute myocardial infarction: interrelation between left ventricular dysfunction, arrhythmias and ischemia. Am J Cardiol 61:7B–12BCrossRefPubMed Gottlieb SH, Ouyang P, Gottlieb SO (1988) Death after acute myocardial infarction: interrelation between left ventricular dysfunction, arrhythmias and ischemia. Am J Cardiol 61:7B–12BCrossRefPubMed
2.
Zurück zum Zitat Hohnloser SH, Klingenheben T, Zabel M, Schopperl M, Mauss O (1999) Prevalence, characteristics and prognostic value during long-term follow-up of nonsustained ventricular tachycardia after myocardial infarction in the thrombolytic era. J Am Coll Cardiol 33:1895–1902CrossRefPubMed Hohnloser SH, Klingenheben T, Zabel M, Schopperl M, Mauss O (1999) Prevalence, characteristics and prognostic value during long-term follow-up of nonsustained ventricular tachycardia after myocardial infarction in the thrombolytic era. J Am Coll Cardiol 33:1895–1902CrossRefPubMed
3.
Zurück zum Zitat Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L et al (1993) Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation 87:312–322CrossRefPubMed Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L et al (1993) Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation 87:312–322CrossRefPubMed
4.
Zurück zum Zitat Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Chaudhary BS, Shapiro S (1981) Ventricular premature complexes and sudden death after myocardial infarction. Circulation 64:297–305CrossRefPubMed Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Chaudhary BS, Shapiro S (1981) Ventricular premature complexes and sudden death after myocardial infarction. Circulation 64:297–305CrossRefPubMed
5.
Zurück zum Zitat Fleg JL, Kennedy HL (1982) Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest 81:302–307CrossRefPubMed Fleg JL, Kennedy HL (1982) Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest 81:302–307CrossRefPubMed
6.
Zurück zum Zitat Fleg JL, Kennedy HL (1992) Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age. Am J Cardiol 70:748–751CrossRefPubMed Fleg JL, Kennedy HL (1992) Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age. Am J Cardiol 70:748–751CrossRefPubMed
7.
Zurück zum Zitat Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ (1985) Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 312:193–197CrossRefPubMed Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ (1985) Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 312:193–197CrossRefPubMed
8.
Zurück zum Zitat Yang SG, Mlcek M, Kittnar O (2014) Gender differences in electrophysiological characteristics of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Physiol Res 63(Suppl 4):451–458 Yang SG, Mlcek M, Kittnar O (2014) Gender differences in electrophysiological characteristics of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Physiol Res 63(Suppl 4):451–458
9.
Zurück zum Zitat Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E et al (2007) Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm 4:863–867CrossRefPubMed Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E et al (2007) Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm 4:863–867CrossRefPubMed
10.
Zurück zum Zitat Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW et al (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 112:1092–1097CrossRefPubMed Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW et al (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 112:1092–1097CrossRefPubMed
11.
Zurück zum Zitat Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F Jr, Latchamsetty R et al (2013) Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes. Heart Rhythm 10:172–175CrossRefPubMed Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F Jr, Latchamsetty R et al (2013) Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes. Heart Rhythm 10:172–175CrossRefPubMed
12.
Zurück zum Zitat Zang M, Zhang T, Mao J, Zhou S, He B (2014) Beneficial effects of catheter ablation of frequent premature ventricular complexes on left ventricular function. Heart 100:787–793CrossRefPubMed Zang M, Zhang T, Mao J, Zhou S, He B (2014) Beneficial effects of catheter ablation of frequent premature ventricular complexes on left ventricular function. Heart 100:787–793CrossRefPubMed
13.
Zurück zum Zitat Carlson MD, White RD, Trohman RG, Adler LP, Biblo LA, Merkatz KA et al (1994) Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 24:720–727CrossRefPubMed Carlson MD, White RD, Trohman RG, Adler LP, Biblo LA, Merkatz KA et al (1994) Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 24:720–727CrossRefPubMed
14.
Zurück zum Zitat White RD, Trohman RG, Flamm SD, VanDyke CW, Optican RJ, Sterba R et al (1998) Right ventricular arrhythmia in the absence of arrhythmogenic dysplasia: MR imaging of myocardial abnormalities. Radiology 207:743–751CrossRefPubMed White RD, Trohman RG, Flamm SD, VanDyke CW, Optican RJ, Sterba R et al (1998) Right ventricular arrhythmia in the absence of arrhythmogenic dysplasia: MR imaging of myocardial abnormalities. Radiology 207:743–751CrossRefPubMed
15.
Zurück zum Zitat Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Hoshizaki H et al (2003) Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 14:1280–1286CrossRefPubMed Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Hoshizaki H et al (2003) Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 14:1280–1286CrossRefPubMed
16.
Zurück zum Zitat Steven D, Roberts-Thomson KC, Seiler J, Inada K, Tedrow UB, Mitchell RN et al (2009) Ventricular tachycardia arising from the aortomitral continuity in structural heart disease: characteristics and therapeutic considerations for an anatomically challenging area of origin. Circ Arrhythm Electrophysiol 2:660–666CrossRefPubMed Steven D, Roberts-Thomson KC, Seiler J, Inada K, Tedrow UB, Mitchell RN et al (2009) Ventricular tachycardia arising from the aortomitral continuity in structural heart disease: characteristics and therapeutic considerations for an anatomically challenging area of origin. Circ Arrhythm Electrophysiol 2:660–666CrossRefPubMed
17.
Zurück zum Zitat Chen J, Hoff PI, Rossvoll O, De BA, Solheim E, Sun L et al (2012) Ventricular arrhythmias originating from the aortomitral continuity: an uncommon variant of left ventricular outflow tract tachycardia. Europace 14:388–395CrossRefPubMed Chen J, Hoff PI, Rossvoll O, De BA, Solheim E, Sun L et al (2012) Ventricular arrhythmias originating from the aortomitral continuity: an uncommon variant of left ventricular outflow tract tachycardia. Europace 14:388–395CrossRefPubMed
18.
Zurück zum Zitat Herczku C, Berruezo A, Andreu D, Fernandez-Armenta J, Mont L, Borras R et al (2012) Mapping data predictors of a left ventricular outflow tract origin of idiopathic ventricular tachycardia with V3 transition and septal earliest activation. Circ Arrhythm Electrophysiol 5:484–491CrossRefPubMed Herczku C, Berruezo A, Andreu D, Fernandez-Armenta J, Mont L, Borras R et al (2012) Mapping data predictors of a left ventricular outflow tract origin of idiopathic ventricular tachycardia with V3 transition and septal earliest activation. Circ Arrhythm Electrophysiol 5:484–491CrossRefPubMed
19.
Zurück zum Zitat Hutchinson MD (2014) Redefining the golden ratio: a novel ECG tool for approaching outflow tract arrhythmias. J Cardiovasc Electrophysiol 25:754–755CrossRefPubMed Hutchinson MD (2014) Redefining the golden ratio: a novel ECG tool for approaching outflow tract arrhythmias. J Cardiovasc Electrophysiol 25:754–755CrossRefPubMed
20.
Zurück zum Zitat Joshi S, Wilber DJ (2005) Ablation of idiopathic right ventricular outflow tract tachycardia: current perspectives. J Cardiovasc Electrophysiol 16(Suppl 1):52–58CrossRef Joshi S, Wilber DJ (2005) Ablation of idiopathic right ventricular outflow tract tachycardia: current perspectives. J Cardiovasc Electrophysiol 16(Suppl 1):52–58CrossRef
21.
Zurück zum Zitat Yu J, Yang B, Chen ML, Chen HW, Ju WZ, Shan QJ et al (2009) Premature ventricular contractions originating from the right ventricular outflow tract: three-dimensional distribution of the target sites and their electrocardiographic characteristics. Clin Exp Pharmacol Physiol 36:834–838CrossRefPubMed Yu J, Yang B, Chen ML, Chen HW, Ju WZ, Shan QJ et al (2009) Premature ventricular contractions originating from the right ventricular outflow tract: three-dimensional distribution of the target sites and their electrocardiographic characteristics. Clin Exp Pharmacol Physiol 36:834–838CrossRefPubMed
22.
Zurück zum Zitat Bogun F, Taj M, Ting M, Kim HM, Reich S, Good E et al (2008) Spatial resolution of pace mapping of idiopathic ventricular tachycardia/ectopy originating in the right ventricular outflow tract. Heart Rhythm 5:339–344CrossRefPubMed Bogun F, Taj M, Ting M, Kim HM, Reich S, Good E et al (2008) Spatial resolution of pace mapping of idiopathic ventricular tachycardia/ectopy originating in the right ventricular outflow tract. Heart Rhythm 5:339–344CrossRefPubMed
23.
Zurück zum Zitat Azegami K, Wilber DJ, Arruda M, Lin AC, Denman RA (2005) Spatial resolution of pacemapping and activation mapping in patients with idiopathic right ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 16:823–829CrossRefPubMed Azegami K, Wilber DJ, Arruda M, Lin AC, Denman RA (2005) Spatial resolution of pacemapping and activation mapping in patients with idiopathic right ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 16:823–829CrossRefPubMed
24.
Zurück zum Zitat Yamada T, Platonov M, McElderry HT, Kay GN (2008) Left ventricular outflow tract tachycardia with preferential conduction and multiple exits. Circ Arrhythm Electrophysiol 1:140–142CrossRefPubMed Yamada T, Platonov M, McElderry HT, Kay GN (2008) Left ventricular outflow tract tachycardia with preferential conduction and multiple exits. Circ Arrhythm Electrophysiol 1:140–142CrossRefPubMed
25.
Zurück zum Zitat Yamada T, Yoshida Y, Inden Y, Murohara T, Kay GN (2010) Idiopathic premature ventricular contractions exhibiting preferential conduction within the aortic root. Pacing Clin Electrophysiol 33:e10–e13CrossRefPubMed Yamada T, Yoshida Y, Inden Y, Murohara T, Kay GN (2010) Idiopathic premature ventricular contractions exhibiting preferential conduction within the aortic root. Pacing Clin Electrophysiol 33:e10–e13CrossRefPubMed
26.
Zurück zum Zitat Yamada T, Doppalapudi H, McElderry HT, Kay GN (2012) Idiopathic mitral annular PVCs with multiple breakouts and preferential conduction unmasked by radiofrequency catheter ablation. Pacing Clin Electrophysiol 35:e112–e115CrossRefPubMed Yamada T, Doppalapudi H, McElderry HT, Kay GN (2012) Idiopathic mitral annular PVCs with multiple breakouts and preferential conduction unmasked by radiofrequency catheter ablation. Pacing Clin Electrophysiol 35:e112–e115CrossRefPubMed
27.
Zurück zum Zitat Bala R, Garcia FC, Hutchinson MD, Gerstenfeld EP, Dhruvakumar S, Dixit S et al (2010) Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm 7:312–322CrossRefPubMed Bala R, Garcia FC, Hutchinson MD, Gerstenfeld EP, Dhruvakumar S, Dixit S et al (2010) Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm 7:312–322CrossRefPubMed
28.
Zurück zum Zitat Carrigan TP, Patel S, Yokokawa M, Schmidlin E, Swanson S, Morady F et al (2014) Anatomic relationships between the coronary venous system, surrounding structures, and the site of origin of epicardial ventricular arrhythmias. J Cardiovasc Electrophysiol 25:1336–1342PubMed Carrigan TP, Patel S, Yokokawa M, Schmidlin E, Swanson S, Morady F et al (2014) Anatomic relationships between the coronary venous system, surrounding structures, and the site of origin of epicardial ventricular arrhythmias. J Cardiovasc Electrophysiol 25:1336–1342PubMed
29.
Zurück zum Zitat Baman TS, Ilg KJ, Gupta SK, Good E, Chugh A, Jongnarangsin K et al (2010) Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system. Circ Arrhythm Electrophysiol 3:274–279CrossRefPubMed Baman TS, Ilg KJ, Gupta SK, Good E, Chugh A, Jongnarangsin K et al (2010) Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system. Circ Arrhythm Electrophysiol 3:274–279CrossRefPubMed
30.
Zurück zum Zitat Daniels DV, Lu YY, Morton JB, Santucci PA, Akar JG, Green A et al (2006) Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva: electrophysiological characteristics, catheter ablation, and identification from the 12-lead electrocardiogram. Circulation 113:1659–1666CrossRefPubMed Daniels DV, Lu YY, Morton JB, Santucci PA, Akar JG, Green A et al (2006) Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva: electrophysiological characteristics, catheter ablation, and identification from the 12-lead electrocardiogram. Circulation 113:1659–1666CrossRefPubMed
31.
Zurück zum Zitat Obel OA, D’Avila A, Neuzil P, Saad EB, Ruskin JN, Reddy VY (2006) Ablation of left ventricular epicardial outflow tract tachycardia from the distal great cardiac vein. J Am Coll Cardiol 48:1813–1817CrossRefPubMed Obel OA, D’Avila A, Neuzil P, Saad EB, Ruskin JN, Reddy VY (2006) Ablation of left ventricular epicardial outflow tract tachycardia from the distal great cardiac vein. J Am Coll Cardiol 48:1813–1817CrossRefPubMed
32.
Zurück zum Zitat Steven D, Pott C, Bittner A, Sultan A, Wasmer K, Hoffmann BA et al (2013) Idiopathic ventricular outflow tract arrhythmias from the great cardiac vein: challenges and risks of catheter ablation. Int J Cardiol 169:366–370CrossRefPubMed Steven D, Pott C, Bittner A, Sultan A, Wasmer K, Hoffmann BA et al (2013) Idiopathic ventricular outflow tract arrhythmias from the great cardiac vein: challenges and risks of catheter ablation. Int J Cardiol 169:366–370CrossRefPubMed
33.
Zurück zum Zitat Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S et al (2001) Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 37:1408–1414CrossRefPubMed Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S et al (2001) Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 37:1408–1414CrossRefPubMed
34.
Zurück zum Zitat Kimura T, Takatsuki S, Fukumoto K, Nishiyama N, Aizawa Y, Miyoshi S et al (2014) Idiopathic ventricular tachycardia cured by radiofrequency application from the distal great cardiac vein and the left coronary cusp. Heart Lung Circ 23:193–196CrossRefPubMed Kimura T, Takatsuki S, Fukumoto K, Nishiyama N, Aizawa Y, Miyoshi S et al (2014) Idiopathic ventricular tachycardia cured by radiofrequency application from the distal great cardiac vein and the left coronary cusp. Heart Lung Circ 23:193–196CrossRefPubMed
35.
Zurück zum Zitat Li YC, Lin JF, Li J, Ji KT, Lin JX (2013) Catheter ablation of idiopathic ventricular arrhythmias originating from left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein. Int J Cardiol 167:2673–2681CrossRefPubMed Li YC, Lin JF, Li J, Ji KT, Lin JX (2013) Catheter ablation of idiopathic ventricular arrhythmias originating from left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein. Int J Cardiol 167:2673–2681CrossRefPubMed
36.
Zurück zum Zitat Schweikert RA, Saliba WI, Tomassoni G, Marrouche NF, Cole CR, Dresing TJ et al (2003) Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations. Circulation 108:1329–1335CrossRefPubMed Schweikert RA, Saliba WI, Tomassoni G, Marrouche NF, Cole CR, Dresing TJ et al (2003) Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations. Circulation 108:1329–1335CrossRefPubMed
Metadaten
Titel
Ursprungslokalisation bei idiopathischen ventrikulären Extrasystolen und Tachykardien aus dem Ausflusstrakt
verfasst von
Dr. Thomas M. Helms
Dr. Antonio Madaffari
Prof. Dr. J. Christoph Geller
Prof. Dr. Matthias Antz
Publikationsdatum
01.09.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 3/2015
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-015-0384-4

Weitere Artikel der Ausgabe 3/2015

Herzschrittmachertherapie + Elektrophysiologie 3/2015 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.