title: Case report: Symptoms of advanced heart failure--a case for radiofrequency catheter ablation?
abstract: A sixty-year-old man with previous history of coronary artery disease was admitted due to progressive worsening of dyspnoea at exertion (NYHA III functional class) and no angina. Coronary angiography confirmed occlusion of the right coronary artery which was naturally bypassed by homocollaterals with TIMI 3 flow to the peripheral branches. The lesion was not technically suitable for percutaneous angioplasty. The left coronary artery was without stenosis. On echocardiography, both the left ventricle and the left atrium were dilated and hemodynamically significant mitral regurgitation was present. Surface ECG showed a left bundle branch block with repeated runs of monomorphic ventricular ectopic beats (PVC). Radiofrequency catheter ablation of the focus in the posteroseptal region of the left ventricle underneath the mitral valve was performed using electroanatomical mapping system. After the procedure, mitral regurgitation decreased and reverse remodeling of the left ventricle and the left atrium occurred with concomitant significant clinical improvement of the patient. The authors discuss several treatment strategies: mitral valve repair surgery combined with revascularization, implantation of a biventricular ICD system or elimination of the focus of monomorphic VT runs by radiofrequency catheter ablation as a possible causal approach in the treatment of PVC-induced cardiomyopathy.
authors.affiliation: Department of Internal Medicine, University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic. alanbulava@seznam.cz
authors.forename: Alan
authors.initials: A
authors.lastname: Bulava
authors.forename: Petr
authors.initials: P
authors.lastname: Heinc
authors.forename: Martin
authors.initials: M
authors.lastname: Hutyra
authors.forename: Milan
authors.initials: M
authors.lastname: Kaminek
authors.forename: Malvina
authors.initials: M
authors.lastname: Krivankova
authors.forename: Marek
authors.initials: M
authors.lastname: Richter
authors.forename: Jan
authors.initials: J
authors.lastname: Lukl
mesh_terms: D018780:Body Surface Potential Mapping; D002037:Bundle-Branch Block / Q000628:therapy*; D002303:Cardiac Output, Low / Q000209:etiology; D009202:Cardiomyopathies / Q000209:etiology; D017115:Catheter Ablation / Q000592:standards*; D017023:Coronary Angiography; D003657:Decision Making; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency; D012815:Signal Processing, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*; D015899:Tomography, Emission-Computed, Single-Photon