베타차단제 복용에도 호전되지 않은 심실조기수축

2020.04

2020.06

 

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2021.01

베타차단제 그리고 또는 non-dihydropyridine CCB로 심실조기수축이 조절되지 않으면 (증상 +/- 빈도) 항부정맥약물을 고려할 수 있고

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항부정맥약물 사용에도 증상이 호전되지 않거나 환자가 항부정맥약물을 복용하고 싶지 않으면 그 다음 선택은 심실조기수축을 없애는 catheter ablation입니다.

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Approach to treatment in patients with premature ventricular complexes (PVCs)

Catheter ablation If beta blockers and/or non-dihydropyridine calcium channel blockers are ineffective or not preferred, and for patients who have had ongoing PVC-related symptoms in spite of antiarrhythmic drug therapy or who prefer not to take antiarrhythmic drug therapy, catheter ablation is an effective option to reduce or eliminate PVCs. In patients with suspected PVC-induced cardiomyopathy and reduced LVEF (<50 percent), catheter ablation should be offered, even in patients already fitted with an ICD in order to improve and possibly normalize LV function. ​ The decision to recommend antiarrhythmic medication or radiofrequency catheter ablation in a particular patient will depend on many clinical factors and also patient preference. Clinical variables that identify a patient most likely to respond to catheter ablation include: ​ ●Unifocal PVCs. ●Frequent PVCs (ie, >10,000 per 24 hours or >10 to 15 percent of total heart beats; there is no uniform consensus on a particular threshold). ●Left bundle branch block inferior axis morphology. ​ Although unifocal PVCs with a right bundle branch block morphology also respond to catheter ablation, this typically will require ablation in the LV and/or aortic root, which is a somewhat more complex catheter ablation procedure as transeptal or retrograde aortic access is needed. ​ In a 2014 systematic review and meta-analysis of small non-randomized studies of radiofrequency ablation for the treatment of idiopathic PVCs originating from the right ventricular outflow tract, catheter ablation was associated with a significant reduction in PVC burden (97 percent mean reduction post-ablation) along with a significant improvement in LVEF (mean increase 10 percent), though the meta-analysis was limited by significant heterogeneity among the studies.