Radiofrequency catheter ablation of drug refractory symptomatic ventricular ectopy: Short- and long-term results

We performed radiofrequency catheter ablation (RFCA) in 12 consecutive pati ents (17-77 years) with daily, symptomatic, monomorphic ventricular ectopy (VE) 12,096 +/- 3,326 on 24-hour Holter) resistant to antiarrhythmic drugs. Nine patients had no apparent structural heart disease, 1 patient had a mi ld dilated cardiomyopathy, 1 patient had a treated mitral stenosis; and 1 p atient had arrhythmogenic ventricular dysplasia. VE morphology was LBBB wit h inferior axis in 9 patients, RBBB with inferior axis in 2 patients, RBBB with superior axis in 1 patient. None of the patients had spontaneous or in ducible sustained ventricular tachycardia. The VE focus was targeted with R F energy at the earliest endocardial activation site and based on a matchin g 12-lead ECG pace map. The VE focus was localized in the right outflow tra ct in 9 patients and on the left ventricle in 3 patients. RFCA was delivere d with a standard 4-mm tip electrode. The ablation was initially successful in 11 patients and unsuccessful in 1 patient. All successfully ablated pat ients were asymptomatic and discharged without antiarrhythmic drugs. During follow-up (25 +/- 8; 17-38 months), two patients had a recurrence of sympt oms, which were controlled by a previously ineffective drug. At the end of follow-up, 1,329 +/- 3198 VE were observed on Holter monitoring (P < 0.001 compared with initial values). No short- and long-term complications were o bserved. RFCA is a safe and effective method for treating drug-resistant sy mptomatic monomorphic VE in carefully selected patients. A persistent benef it without complications was obtained over a 2-year follow-up.