S.P.I Nasruddin1, Irnizarifka1,2
1Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
2Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Sebelas Maret University Hospital, Surakarta, Indonesia.
Background: Premature Ventricular Contraction (PVC) is very common arrhythmia found in clinical practice. It may occur in healthy individual with no evidence of structural heart disease and most originate from right ventricular outflow tract (RVOT)1. Idiopathic RVOT-PVC typically presents between the ages of 20 to 50 years and more frequent in women. When highly symptomatic or refractory to antiarrhythmic therapy, catheter ablation is recommended due to its > 95% success rate and a extremely low complication risk2.
Case illustration: 27-year-old female came to outpatient clinic with chief complaint of recurrent palpitation. Frequent RVOT origin PVCs (unifocal, 50%) with coupling interval of 360 msec were obtained on Holter ECG monitor. Echocardiography did not evidence any structural heart diseases and revealed normal LVEF, whereas cardiac CT showed normal coronary arteries. Magnetic resonance imaging was done and revealed normal cardiac chamber, with no sign of arrhythmogenic right ventricular dysplasia or arrhytmogenic mitral valve prolapse. Verapamil was then initiated, but failed to improve her symptom and ECG. Electrophysiological study was finally done and showed unifocal RVOT-PVC with focal area at anteroseptal region. Radiofrequency ablation was performed (40 watts, 500 celsius, 180 msec) without any complications. Evaluation showed normal sinus rhythm with no inducible PVC, and patient did not experience any more symptoms.
Conclusion: We have managed a young woman with frequent idiopathic RVOT-PVCs who are still symptomatic despite optimal anti-arrhythmic medication. Echocardiography, cardiac CT, and MRI showed no underlying structural heart disease and exclude arrhythmogenic right ventricular dysplasia. Timely decision to do radiofrequency ablation is particularly effective and safe to treat persistent and symptomatic idiopathic RVOT-PVC, with very low complication rate.
Keyword: radiofrequency catheter ablation, right ventricular outflow tract arrhythmia, premature ventricular contraction.
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