| Background:Premature ventricular contractions(PVCs) and ventricular tachycardias(VTs) inpatients without structural heart diseases has been called as idiopathic ventriculararrhythmias(IVAs),The detection rates of normal electrocardiograph, and Holter were1-4%and40-75%, respectively[1]. About80-90%of them originated from right ventricularoutflow tract(RVOT)[2], the rest of origin sites including left venricular outflowtract(LVOT), His bundle, pulmonary valve，mitral/tricuspid annulus and other sites. Theearly stduies showed IVAs had a benign prognosis and had no need for special treatment.But recent studies confirmed that IVAs was not a so-called benign disease. TheFramingham study found[3]that seeming healthy individuals with PVCs had the relativeincreased risk of sudden cardiac death and mortality, long-term frequent VAs in normalpeople could interfere with the heart function and result in cardiac dysfunction andcardiomyopathy,or cardiac remodling[4]. The implementation of interventions for IVAs stillexist numerous controversies. Some antiarrhythmic drugs(AADs) had certain curativeeffects, but the long-term advantage was called in question due to the potentialproarrhythmia risks. Catheter ablation, acted as a safty and effective therapy method fortreating some patients with ventricular arrhythmias which have special heart background,have acquired favorable effect, but whether catheter ablation could get a similar effect inpatients with IVAs is still lacking of related chinical studies. Objective:To compare the changes of the structure and function of heart in patients with IVAsbefore and after catheter ablation, evaluate the quality of life(QOL) at different sub-groupswith IVAs in order to provide more clinical evidences for the diagnosis and treatment ofIVAs.Methods:According to inclusion criterion and exclusion criteria，total170patients with IVAs inour department experienced catheter ablation had complete clinic data and follow up inhospital from March1in2012to February1in2014. All patients with IVAs have beendivided into two groups: group A1(PVC burden<20%) and group A2(PVC burden≥20%) bya20%burden cutoff[1]. The data of ultrasonic,blood biochemistry and QOL between groupA1and group A2were compared;170patients with IVAs received catheter ablationnavigating by carto mapping system(a three dimensional electrical anatomy mappingsystem), and accomplished follow-up at3month and6month after at3months and6months after catheter ablation respectively, and all data were also recorded and analysed byutilizing SPSS13.0software.Results:1) The group comparison before catheter ablation: N-terminal pro-brain natriureticpeptide(NT-proBNP) level in group A2is significantly higher than that groupA1(148.36±126.72pg/ml VS113.11±98.01pg/ml, P=0.04); Left Atrial Volume maximum(LAVmax) and Left Atrial Volume Index (LAVI) in group A2are significantly larger thanthose group A1(LAVmax:44.45±13.73ml VS40.61±13.01ml, P=0.034; LAVI:25.60±7.16ml/m2VS23.84±8.43ml/m2, P=0.023). The other clinical data including hsCRPhad no statistical differences.2) The comparison before and after catheter ablation in patients experienced successfulcatheter ablation:①NT-proBNP at3month and6month after ablation signifcantlydecreased compred to that before ablation(65.54±53.78pg/ml and44.73±37.56pg/ml VS124.65±110.89pg/ml, P values <0.001);②Left atrial diameter(LAD), Left ventricularend-diastolic diameter(LVEDD), LAVI, LAVmax and Left Atrial Volume minimum (LAVmin) at3month and6month after ablation were lower than those of pre-operative(Pvalues <0.001), LAD of32.77±4.63mm at3month and32.74±4.46mm at6month VS34.35±5.62mm before ablation, LVEDD of47.69±5.68mm at3month and48.16±4.81mmat6month VS49.02±5.31mm before ablation, LAVmax of38.62±10.40ml at3month and39.34±12.25ml at6month VS41.75±12.82ml before ablation, LAVmin of15.56±5.78mmat3month and15.56±7.69mm at6month VS19.09±8.41mm before ablation, LAVI of22.59±6.81ml/m2at3month and22.82±7.29ml/m2at6month VS24.29±7.66ml/m2beforeablation; However, LVEF and LAEF after ablation were markedly higher than those ofpreoperative: LVEF of64.69±6.97%at3month and65.90±5.8%at6month VS63.20±6.69%before ablation(P value=0.003and less than0.001); LAEF of39.36±11.00%at3month and41.00±10.20%at6month VS31.95±9.15%before ablation(Pvalues<0.001).③All QOL score after operation obviously improved compared to that ofpre-operation(P values <0.001).3) The comparison before and after catheter ablation in patients experienced a failurecatheter ablation:①LVEF and LAEF at3month and6month after ablation are markedlylower than those of pre-operative, LVEF of55.09±9.45%at3month and57.64±6.76%at3month VS61.11±9.21%before ablation(P value=0.03and less than0.01)，LAEF of34.65±9.66%and35.02±9.32%VS36.82±11.2%(P value=0.01and less than0.001). Theother data including QOL scores had no statistical differences compared with those ofpre-operation.Conclusion:1) PVC bruden may be related to the structure and function of heart；2) Catheterablation could be useful for the improve of the structure and function of left heart andhelpful for alleviating unwell symptoms and increasing QOL in cases of IVAs；3) Catheterablation is a safty and effective treatment of elimination of IVAs. |
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