Tesis

Hubungan Sudut Aortoseptal secara Ekokardiografi dengan Sumber Aritmia Jalur Keluar Ventrikel = Association Between Aortoseptal Angulation Measurement by Echocardigraphy with Origin of Outflow Tract Ventricular Arrhythmia.

Latar belakang: Aritmia jalur keluar ventrikel (AJKV) adalah aritmia yang sering didapatkan pada populasi umum. Ablasi radiofrekuensi merupakan modalitas terapi dengan tingkat keberhasilan yang tinggi pada AJKV. Menentukan lokasi sumber aritmia penting dilakukan karena akan membantu dalam memilih tehnik ablasi, menghindari komplikasi, serta menghemat waktu fluoroskopi. Algoritma EKG adalah metode yang telah luas dipergunakan untuk memprediksi sumber AJKV, namun membutuhkan keterampilan dalam analisis dan interpretasi EKG. Studi sebelumnya menduga bahwa terjadinya AJKV kiri disebabkan adanya perubahan anatomi aorta. Tujuan: Penelitian ini bertujuan untuk menilai hubungan antara sudut aortoseptal yang dinilai secara ekokardiografi dengan sumber AJKV Metode: Studi potong lintang pada 60 pasien pascaablasi AJKV. Sudut aortoseptal diukur pada gambar parasternal long axis (PLAX) secara ekokardiografi, sumber AJKV ditentukan berdasarkan pemetaan saat tindakan radiofrekuensi ablasi. Selanjutnya hubungan antara keduanya dianalisis secara statistik, baik analisis bivariat maupun multivariat. Hasil: Terdapat 60 subyek penelitian dengan rerata usia 47+14 tahun. Mayoritas subyek merupakan pasien dengan AJKV kanan (n=40, 66.7%). Analisis bivariat menunjukkan bahwa terdapat perbedaan yang signifikan pada variabel usia, tebal septum interventrikular dan sudut aortoseptal antara pasien dengan AJKV kanan dan kiri (p < 0,05). Analisis receiver operating characteristic (ROC) dan analisis multivariat menunjukkan bahwa sudut aortoseptal < 129.2 o merupakan variabel yang secara independen berhubungan dengan sumber AJKV kiri (OR 8.98; IK 2.39 – 33.75; p=0.001). Kesimpulan: Terdapat hubungan antara sudut aortoseptal yang diukur secara ekokardiografi dengan sumber AJKV.
Kata Kunci: aritmia jalur keluar ventrikel, sudut aortoseptal, ablasi radiofrekuensi


Background: Outflow tract ventricular arrhythmias (OTVA) are frequent arrhythmias often found in the general population. Radiofrequency ablation has become a therapeutic modality with a high success rate for OTVA. Determining the origin of OTVA before ablation is important because it will help in choosing a different approach, avoiding multiple complications, and saving fluoroscopy time. ECG-based criteria is a method that has been widely used to predict the origin of OTVA, but requires skills in ECG analysis and interpretation. Previous studies suspected that the occurrence of left OTVA is due to aortic root anatomical changes. Objective: To assess association between aortoseptal angulation measurements by echocardiography and OTVA origin. Methods: A cross-sectional observational study in 60 patients after OTVA ablation. Aortoseptal angulation is measured on parasternal long axis (PLAX) view on echocardiographic examinations, origin of OTVA determined based on mapping during radiofrequency ablation. Furthermore, association between this variable was analyzed statistically, with bivariate and multivariate analysis. Results: There were 60 subjects with a mean age of 47+14 years. Majority of subjects were patients with right OTVA (n = 40, 66.7%). Bivariate analysis showed that there were significant differences in age, interventricular septum thickness and aortoseptal angulation between patients with right and left OTVA (p < 0.05). Receiver operating characteristic (ROC) analysis and multivariate analysis showed that the aortoseptal angulation < 129.2˚ was a variable that was independently related to the left OTVA origin (OR 8.98; IK 2.39 - 33.75; p = 0.001). Conclusion: There is a association between aortoseptal angulation measurement by echocardiography with OTVA origin
Keywords: outflow tract ventricular arrhythmia, aortoseptal angulation, radiofrequency ablation