RỐI LOẠN NHỊP THẤT Ở BỆNH NHÂN CÓ ĐỘNG MẠCH VÀNH XUẤT PHÁT BẤT THƯỜNG: NGUYÊN NHÂN ĐỘT TỬ HAY BỆNH LÝ ĐỒNG MẮC

Abstract

Objective: To report clinical cases of ventricular arrhythmias associated with coronary artery anomalies successfully treated with catheter ablation using a 3D electroanatomic mapping system. Background: There have been no previous reports in Vietnam on the efficacy of ventricular tachycardia ablation in patients with coronary artery anomalies. Methods: Cases report. Results: Two patients presented with pre syncope and refractory ventricular tachycardia and were diagnosed with congenital coronary artery anomalies. The first patient was a 54-year-old female who had a left main coronary artery originating from the right coronary sinus, heart failure (LVEF 29%), and a ventricular arrhythmia burden of 49%. A 42-year-old male had a right coronary artery arising from the left Valsalva sinus, with non-sustained ventricular tachycardia and an arrhythmia burden of 8%. Both underwent successful catheter ablation using 3D electroanatomic mapping in the right ventricular outflow tract, effectively eliminating premature ventricular tachycardia without damaging the underlying transverse coronary artery. The patients remained asymptomatic and no arrhythmia recurrence was detected on 24-hour Holter monitoring at a 3-month follow-up associated with normalized left ventricular function of the first case. Both of these two patients refused to have coronary artery reimplantation due to asymptomatic status after ventricular tachycardia ablation. Conclusion: Although anomalous aortic origin of coronaries with inter-arterial course  were reported to have high risk of sudden death, the coincidence with right outflow tract ventricular tachycardia was associated with better outcome after catheter ablation guided by electroanatomic mapping.