or frequent premature ventricular contractions (PVCs) can occur in the absence
of any detectable structural heart disease. In this clinical setting, these
arrhythmias are termed idiopathic. Usually, they carry a benign prognosis and
any potential ablative intervention is carried out if patients are highly
symptomatic or, more importantly, if
frequent ventricular arrhythmias can lead to ventricular dysfunction.
In this paper,
different forms of idiopathic ventricular tachycardia are reviewed. Outflow
tract ventricular tachycardia from the right ventricle is the most frequent
form of the so-called idiopathic
ventricular tachycardia. Other forms of
idiopathic ventricular arrhythmias include ventricular tachycardia/PVCs
arising from tricuspid annulus, from the mitral annulus, inter-fascicular ventricular
tachycardia and papillary muscle ventricular tachycardia. When interventional
treatment is deemed necessary, detailed mapping ( earliest activation during
VT/PVC, pace mapping ) is crucial as to identify the successful ablation site.
Catheter ablation more than antiarrhythmic drug treatment is usually highly effective in eliminating idiopathic
ventricular arrhythmias and providing prevention of recurrence.
Idiopathic VTs are not considered life-threatening
arrhythmias and, prevention of recurrences is often achieved by means of catheter
ablation that provides an improvement of quality of life. The overall acute
success rate of catheter ablation is about 85-90% with a long–term prevention
of arrhythmia recurrence of about 75-80%. It is advisable that the procedure is
carried out by electrophysiologists with expertise in VT catheter ablation and
extensive knowledge of cardiac anatomy as to ensure a high success rate and
reduce the likelihood of major complications.
Credits: Claudio Tondo; Corrado Carbucicchio; Antonio Dello Russo; Benedetta Majocchi; Martina Zucchetti; Francesca Pizzamiglio; Fabrizio Bologna; Fabio Cattaneo; Daniele Colombo; Eleonora Russo; Michela Casella