CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
e7
right ventricular outflow tract, and the earliest activation site is
sought by competition. Using this technique, diagnosis of right
ventricular outflow tract ventricular tachycardia was established.
To the best of our knowledge, right ventricular outflow
tract ventricular tachycardia in association with left ventricular
non-compaction has never been reported. We could not determine
whether the occurrence of both together was serendipitous or
whether there was some relationship between the two.
Right ventricular outflow tract ventricular tachycardia is a
curable form of ventricular arrhythmia. Verapamil, beta-blockers
and adenosine are used in acute and prophylactic treatment of
this arrhythmia.
Radiofrequency ablation is an alternative treatment modality
with reported cure rates of 90%,
9
which makes it a preferable
option, given the young age of patients with right ventricular
outflow tract ventricular tachycardia. In addition, normalisation
of left ventricular systolic dysfunction has been reported after
right ventricular outflow tract ventricular tachycardia ablation.
10,11
In our case, the cardiomyopathy was also improved shortly after
elimination of the repetitive premature ventricular contractions
by radiofrequency ablation.
Myocardial morphology of left ventricular non-compaction
usually results in heart failure and patients may be prone to the
development of cardiomyopathy in cases of tachycardia.
5
Also,
right ventricular outflow tract tachycardia may be induced from
the remote cellular mechanism of the non-compacted segment,
5,12
or it may induce heart failure in the potentially tachycardia-
sensitive myocardium of left ventricular non-compaction.
5
Güvenç
et al.
12
reported a patient with exercise-induced
ventricular tachycardia with left bundle branch block
morphology, who had characteristics of idiopathic ventricular
tachycardia, which was subsequently diagnosed as left ventricular
non-compaction. Successful remission of the arrhythmia was
ensured after the introduction of oral beta-blocker therapy.
12
Oral beta-blockers are recommended as class Ia indication
in patients with non-compaction but not in patients with
RVOT ventricular tachycardia. Remission of RVOT ventricular
tachycardia may be due to suppression of the arrhythmic trigger
of the non-compacted segment by remote cellular mechanism.
Conclusion
Although we could not establish a direct association between
left ventricular non-compaction and right ventricular outflow
tract ventricular tachycardia, this should be kept in mind in
such cases. Curable forms of ventricular arrhythmias should be
carefully sought, even in patients with non-compaction and heart
failure.
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