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Você sabe que várias arritmias são passíveis de ablação e com grande chance de cura definitiva?

Publicado por Marcelo Carrijo

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As extrassístoles ventriculares costumam ser muito sintomáticas e algumas vezes causa de dilatação cardíaca com prejuízo na função de bomba podendo evoluir com insuficiência cardíaca. A alta densidade da extrassístole pode ser facilmente avaliada pelo Holter; este é o fator mais importante de mal prognóstico na função ventricular (densidades acima de 13%). Outros fatores de risco para insuficiência cardíaca são: período de acoplamento longo, distribuição homogênea da arritmia durante as 24 horas, largura do QRS da extrassístole > 170 ms e ser assintomático (demoram mais a procurar assistência médica atrasando o diagnóstico).

Mostro em seguida uma ablação de extrassístole ventricular da via de saída do ventrículo esquerdo, frequente considerada “benigna”. A paciente, de 62 anos, apresentava 32% de densidade da extrassístole no Holter e vinha evoluindo com palpitação não taquicárdica e cansaço aos médios esforços nos últimos 3 meses. O ecocardiograma evidenciou disfunção moderada do ventrículo esquerdo com fração ejeção calculada de 41%.

Foi utilizado o mapeamento eletroanatômico com reconstrução em 3D da via de saída do ventrículo esquerdo. Pelo mapa de ativação da extrassístole (vídeo 1) identifica-se foco em região entre as cúspides aórticas coronariana esquerda e não coronariana. O vídeo 2 mostra a posição do cateter ablador a nível da valva aórtica pela radioscopia. A aplicação de radiofrequência (ablação) no local de maior precocidade elétrica foi possível eliminar a extrassístole conforme visto no eletrocardiograma 2.

Clínica de Arritmias em Uberlândia Dr. Marcelo Carrijo

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