Indications for RFA in ventricular extrasystoles

Extrasystole is a fairly common phenomenon, during which an unauthorized strong contraction of the whole heart as a whole or its components (extrasystoles) occurs. The patient at the same time feels a strong push in the sternum, accompanied by a sharp lack of oxygen, a rush of blood to the face and neck, weakness and a feeling of growing anxiety. As a result, there is a decrease in the force of ejection of blood by the heart, which disrupts the coronary and cerebral circulation. If extrasystoles occur too often, this can lead to a deterioration in brain function, aggravation of other heart diseases, atrial fibrillation and angina, up to death. One of the methods of treatment of extrasystoles is radiofrequency ablation, which is designed to eliminate this disease or reduce the frequency of its manifestation to a minimum.

What are extrasystoles and classification

Extrasystoles are extraordinary sensible contractions of the heart. The contractile process is explained by the formation of highly active ectopic formations in the atrium, right and left ventricles, as well as in the atrioventricular node, while, according to the norm, such formations should be located only within the boundaries of the sinus node. In these formations, electrical impulses arise that cause the heart to contract during diastole (complete relaxation of the heart muscles), which causes an extraordinary release of blood. But due to the fact that the volume of blood ejected during an extrasystole is lower than normal, the total volume of blood circulation decreases markedly within one minute.

Isolated cases of extrasystoles can also be observed among absolutely healthy people. Statistics show that most people of mature age (over 45 years old) have frequent isolated cases of extrasystoles.

1. At the site of formation of foci of excitation of the contraction impulse, ventricular (more than 60% of cases), atrial (about 25% of cases), atrioventricular extrasystoles (more than 10%), an atrioventricular connection impulse (no more than 3%) and the most rare extrasystoles caused by the main driver of the heart rhythm is the sinus node (less than 1%).
2. According to the frequency of the contraction rhythm, there are: parasystole - the formation of two rhythms (extrasystolic and sinus) at the same time; paired extrasystoles - impulses that occur in a row one after another; volley - multiple extrasystoles, heart contractions occur one after another with virtually no pauses.
3. Allorhythmias - regular alternation of extrasystoles and normal systoles in a different order: bigeminia - an alternate manifestation of normal contraction of the heart muscles (systole) and abnormal - extrasystoles; trigeminia - two normal systoles and one extrasystole occurring one after another; quadrihymenia - extrasystole, following every third normal systole.
4. According to the time of manifestation of electrosystoles, they are divided into early, middle and late. With an electrocardiogram, you can see an early extrasystole simultaneously with a T-shaped tooth (+ - 0.1 seconds), an average one after half a second and a late one before a normal heart systole.
5. According to how often abnormal heart contractions occur, rare extrasystoles (less than 5 per minute), medium (from 5 to 15) and frequent (more than 15 contractions per minute) are distinguished.
6. According to the number of places of formation of active foci of extrasystole, there are monotopic (one focus) and polytopic (2 or more foci of excitation).
7. The etiology of extrasystoles can have a functional origin, as well as organic and toxic.

Causes of extrasystole

In extrasystoles of various etiologies, separate reasons for their formation are distinguished.

• violation of the nervous and mental activity of the body due to the use of alcohol and drugs, poor-quality food or poisoning with chemicals of a different nature;
• osteochondrosis;
• vegetovascular dystonia;
• regular physical activity;
• menstruation (in women);
• stress;
• frequent use of strong coffee.

Functional extrasystoles can also occur in absolutely healthy people in a single order and at any age.

• cardiac ischemia;
• pericarditis (inflammation of the pericardial sac);
• development of cardiosclerosis;
• advanced myocarditis (inflammation of the myocardium);
• extensive myocardial infarction;
• cor pulmonale and other diseases of the bronchopulmonary system;
• cardiomyopathy;
• acute heart failure;
• congenital and acquired heart defects;
• surgical intervention.

What is radiofrequency ablation (RFA)

The operation of radiofrequency ablation, or as this process is also called - "cauterization of the heart" - is a radical modern method of treating heart diseases with varying degrees of rhythm disturbance.

This technique is based on radiofrequency exposure to a pathogenic tissue site, which generates an extraordinary impulse (focus) with its subsequent removal. In simple terms, during RFA there is damage to the complementary impulse pathway while the normal heart beat pathways remain healthy.

• atrial fibrillation;
• heart failure;
• ventricular and supraventricular tachycardia;
• ERW Syndrome (congenital pathology of the passing system).

The appointment of RFA occurs in a planned manner after a complete diagnosis and examination of the patient and the identification of contraindications to surgery, such as acute heart attack and acute stroke, inflammation, fever, anemia and renal failure.

List of examinations and diagnostic measures before surgery:

1. General analyses.
2. ECG and Holter ECG.
3. Blood clotting test.
4. TPEFI - localization of foci by means of a transfood electrophysiological study.
5. Coronary angiography (CAG) for patients with coronary artery disease.
6. ENT.
7. Stamotolog.
8. Urologist or gynecologist (depending on the gender of the patient).
9. Blood test for viral infections, hepatitis, HIV.

• combined anesthesia - a local anesthetic is applied to the area of ​​\u200b\u200bthe femoral artery or vein of the inguinal region and a catheter with a sedative is inserted;
• a probe is inserted into the cardiac cavity through a conductor (introducer) to visualize the state of tissues and localize foci;
• then there is an endovascular electrophysiological study (EPS). Different parts of tissues are affected by electrodes through introducers, and if the heart rate has not changed, then this area does not need to be cauterized;
• after detection of active foci, they are subjected to radiofrequency ablation (complete destruction);
• After the operation, the cardiologist monitors the patient's heart rate in order to avoid missing an active focus.

Extrasystoles after RFA

During the operation of radiofrequency ablation, the foci that cause extraordinary cardiac impulses are blocked or completely removed.

• observance of the rest mode;
• postoperative diet;
• regimen for taking recommended medications;
• supervision of a cardiologist;
• exclusion of substances provoking arrhythmia (alcohol, strong tea and coffee, caffeinated foods and drinks.

Single, and even repetitive extrasystoles can absolutely say nothing. Such a manifestation of extraordinary impulses is most often functional in nature and practically has nothing to do with the radiofrequency ablation performed.

In very rare cases, frequent extraordinary impulses may be associated with the formation of a new focus of excitation.

Since after the operation, doctors monitor the heart rate for the presence of extrasystoles for 20-30 minutes, the excitation of the old (not removed) focus is almost completely excluded.