Ventricular extrasystole – induced cardiomyopathy

Vedran Velagic
2014 Cardiologia Croatica  
SAAEETAK: Ventrikulske ekstrasistole (VES) Ëesta su i naËelno benigna pojava, osobito ako se radi o bolesniku sa strukturno zdravim srcem. 1998. godine objavljena je prva studija u kojoj je dokazano da medikamentozna supresija ekstrasistolije rezultira oporavkom funkcije lijeve klijetke u dilatacijskoj karidomiopatiji te je razvijen koncept VES inducirane kardiompatije (CMP). Sama pojavnost VES vrlo je velika u populaciji, raste s dobi, no toËne podatke o incidenciji VES inducirane
more » ... cirane kardiomiopatije nemamo. Najvaaeniji Ëimbenik u razvoju ovog entiteta je "VES optereÊenje"" no joπ se vode polemike oko toËne definicije istog. Razvijeno je nekoliko aeivotinjskih modela za rasvjetljavanje patofiziologije ove bolesti te se najvjerojatnije radi o funkcijskom poremeÊaju koji je u velikoj mjeri reverzibilan. U obradi ovih bolesnika potrebno je na sve dostupne naËine detektirati sekundarne uzroke ekstrasistolije i kardiomiopatije, jer je VES inducirana CMP dijagnoza do koje dolazimo iskljuËivanjem. Od terapijskih opcija na raspolaganju nam je medikamentozna terapija antiaritmicima te kateterska radiofrekventna (RF) ablacija. Randomizirane studije koje bi dale prednost jednoj od ovih opcija ne postoje. U posljednje vrijeme preferira se RF ablacija s vrlo dobrim razultatima u reverziji kardiomiopatije i s malom uËestalosti komplikacija. U ovom trenutku, VES inducirana CMP joπ je prerijetko prepoznata kao uzrok neishemijske kardiomiopatije. KLJU»NE RIJE»I: ventrikulske ekstrasistole, kardiomiopatija, antiaritmici, radiofrekventna ablacija. SUMMARY: Ventricular extrasystoles (PVC, Premature Ventricular Contraction) are a common and generally a benign phenomenon, especially in a patient with a structurally normal heart. The first study was published in 1998 which proved that medical suppression of extrasystole results in the recovery of the left ventricular function in dilatation cardiomyopathy, whereas the concept of PVC-induced cardiomyopathy (CMP) was developed. The incidence of PVCs itself is very large in population, rises with age, but we have no accurate data on the incidence of PVC-induced cardiomyopathy. The most important factor in the development of this disease is "PVC burden", but the exact definition thereof is still being discussed. Several animal models have been developed for elucidating the pathophysiology of this disease and it is probably a functional disorder that is largely reversible. In the treatment of these patients it is necessary to detect secondary causes of extrasystole and cardiomyopathy in all available ways; because the PVC-induced CMP is diagnosis of exclusion. Out of therapeutic options we have antiarrhythmic drug therapy and catheter radiofrequency (RF) ablation at disposal. There are no randomized studies that would prefer one of these options. RF ablation, with very good results in the reversion of cardiomyopathy and with a low incidence of complications, has been preferred lately. At this point, PVC-induced CMP is still too seldom recognized as a cause of non-ischemic cardiomyopathy.
doi:10.15836/ccar.2014.28 fatcat:yukk2kvvmfc3fialybz6jyxzwq