PubMed · 7545652
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J Tebbenjohanns, B Lüderitz. 1995. [Extrasystole].. https://pubmed.ncbi.nlm.nih.gov/7545652/
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A case report of a man with ventricular concealed trigeminy in whom ventricular couplets initiating paroxysmal supraventricular tachycardia were occasionally seen is reported. This is the first report on concealed trigeminy with couplets. This strengthens the authors' previous suggestion that supernormal conduction may occur in the reentrant pathway of extrasystoles, as a mechanism of ventricular couplets.
The article has summarized the studies and ongoing trials looking at the significance and treatment of ventricular tachyarrhythmias. In most instances, the presence of these arrhythmias is associated with an increased risk of future arrhythmic events. Electrophysiologic studies are helpful in risk stratification in patients with coronary artery disease but can be misleading in the setting of dilated cardiomyopathy and often produce nonspecific results in patients with HCM. The need for an invasive electrophysiologic study is crucial in the diagnosis of certain ventricular arrhythmias that are amenable to cure with radiofrequency catheter ablation, such as idiopathic ventricular tachycardia and BBR-VT. The correct approach for patients with SVT not amenable to catheter ablation remains to be determined. In deciding whether to use a device or drug therapy, however, one should take into consideration the degree of left ventricular dysfunction and the overall health status of the patient. For example, device implantation clearly reduces sudden death in patients with severe left ventricular dysfunction but may not change total mortality because these same patients may die of congestive heart failure. Device therapy might be more cost-effective for patients with less severe depression of left ventricular function.
In a 52-year-old patient with beginning dilatative cardiomyopathy dizziness and syncopes could be observed due to a ventricular bigeminy at rest and under exercise conditions. The patient also showed a marked reduction of exercise capacity and was handicapped in his profession as electrician and unable to work for more than 10 months. Antiarrhythmic drug therapy including the subsequent use of all available antiarrhythmic agents failed in suppressing this arrhythmia. In an electrophysiological study the arrhythmogenic focus could be localized in the right ventricular outflow tract. Application of radiofrequency current resulted in instantaneous termination of the extrasystoly; this result could be documented in repeat Holter monitorings over 12 weeks to present. This case report shows that radiofrequency catheter ablation can in special cases be applied for therapy of extrasystolic phenomena when clinical symptoms necessitate treatment and antiarrhythmic drug therapy fails.