Ventriküler Ekstrasistol (Ves) Ablasyonu Yapılan Hastaların Laboratuvar, Klinik, Ekokardiyografik ve Elektrokardiyografik Özellikleri ile Uzun Dönem Takip Sonuçlarının Değerlendirilmesi

Abstract

SEZGİN A. Evaluation of Laboratory, Clinical, Echocardiographic and Electrocardiographic Characteristics and Long-Term Follow-up Results of Patients who had Ventricular Extrasystole (VES) Ablation, Hacettepe University Faculty of Medicine, Thesis in Cardiology, Ankara 2022. VES is an arrhythmic disease seen with a frequency ranging from 1-75% in the community. QRS duration is >120 milliseconds (ms) After QRS complex, there is T wave in the opposite direction of QRS complex and there is no P wave before. VESs originate in the ventricular tissues of the heart outside the atria. Triggered activity in idiopathic pathophysiology, reentry or increased automaticity if there is an underlying disease are responsible. Diagnosis can be made by clinical presentation, Electrocardiography (ECG) and/or Holter. In addition, Echocardiography(ECHO) and, if necessary, scintigraphy, computed tomography or cardiac magnetic resonance imaging can be used in terms of etiology. There are medical treatment and catheter ablation options in the treatment. Beta blockers, calcium channel blockers and antiarrhythmics can be used as drugs. The aim of our study is to evaluate retrospectively patients, who underwent VES ablation, in terms of clinical, ECHO and ECG features and long-term follow-up results, and to examine idiopathic VES originating from the outlet tract in more detail with their ECG features. Additionally the aim is to collect the parameters of 7 algorithms that predict the origin of VES from the 12-lead recordings taken before ablation and compare and them to create a new algorithm. 129 patients who had received catheter ablation for idiophatic VES originating from outflow tract between the dates of 1 January 2010-1 June 2020, were included in the study. Of the patients, 13 (10.1%) had Right Bundle Branch Block (RBBB) and 116 (89.1%) had Left Bundle Branch Block (LBBB) morphology. 54(41.6%) patients had ventricular extrasystole’s originating from Right Ventricular Outflow Tract (RVOT) and 75(58.4%) patients had ventricular extrasystole’s originating from Left Ventricular Outflow Tract (LVOT). 12 (98.1%) of the 13 patients who had RBBB morphology, had LVOT originating VES. Event-free survival at 122 patients for which long-term information was available was 57.29 months (95% CI; 49.08-65). Among the 7 algoritms examined, Combined Transition Zone (TZ) index had the highest sensitivity (90.48%) and positive predictive value (85.37%), R Wave Duration Index and R/S Amplitude Index algortim had the highest specificity (98.11%) and positive predictive (94.74). After the TZ index algorithm correctly predicted 43 (97.7%) of 44 patients in whom the R Wave Duration Index and R/S Amplitude Index algorithms gave false negative results, these two algorithms were combined. The sensitivity of the new algorithm was 98%, the specificity was 30%, the positive predictive value was 63%, the negative predictive value was 94%. Using logistic regression analysis method with algorithm components Y=8.436 – 2.036 x (VES TZ score) - 0.06 x (VES V2 lead R wave duration)+ 4.661 x (VES V3 lead R wave amplitude) - 1.958 x (VES V2 lead S wave amplitude) algorithm was created. In a retrospective comparison, the LVOT sensitivity of the new algorithm for Y>0.5 was 84.4%, the specificity was 82.7%, the positive predictive value was 85.7%, and the negative predictive value was 81.1%. Keywords: Ventricular Extrasystole, Idiopathic Premature ventricular complexes, Catheter Ablation, ECG Algorithm