Unique features of epicardial ventricular arrhythmias/premature ventricular complexes ablated from coronary venous system in veteran population

Newer diagnostic criteria for identification of epicardial origin of ventricular tachycardia/premature ventricular complex

Aim: The study defines criteria for localization of ventricular arrhythmias. Materials & methods: Data from 40 premature ventricular complex (PVC)/ventricular tachycardia (VT) were studied. The interval from PVC QRS onset to His potential and ratio of this interval to PVC/VT QRS duration was analyzed. Patients were divided into epicardial and endocardial groups based on mapping/successful ablation site. Results: The interval from PVC QRS onset to His potential in the epicardial versus endocardial group was 99 ± 21 ms and 64 ± 37 ms (p = 0.002). A cut off of 88 ms had a sensitivity of 73% and specificity of 76%. A cut off of 0.50 for the ratio had a sensitivity of 82% and specificity of 72%. Conclusion: Two new parameters can help localization of PVC/VTs origin.

Mechanical suppression of premature ventricular complexes during catheter ablation procedures

Introduction

Mechanical suppression of premature ventricular complexes (PVCs) is not a well-known observation. We retrospectively reviewed this phenomenon in the Ventricular Arrhythmia (VA) ablation procedures performed at Richard L. Roudebush Veterans Health Administration (VHA) center.

Methods

Data from 40 consecutive patients who underwent VA ablation at VHA, Indianapolis, IN, with 44 VA was included in the study. Demographic and electrophysiological parameter data was collected.

Results

Overall the mean age of the population was 64 ± 11 years. The phenomenon of mechanical suppression was seen in 11 PVCs. The mean age was 59 ± 15 years in the group in which mechanical suppression was seen. Of the 11 cases, the site of earliest activation was seen in the coronary sinus in 8 and in the pulmonary artery in 3. In one case catheter ablation was not performed because of proximity to the left coronary artery system. However, sustained pressure at the site with earliest electrograms (−35 ms) and 95% pacematch resulted in long-term suppression of PVCs. In the cases in which mechanical suppression was seen, there was a statistically significant reduction in PVC burden compared to pre ablation PVC load (1.1% ± 1.50% (post ablation) versus 24.04% ± 13.07% (pre ablation) versus p < 0.05).

In all the 11 cases the site of mechanical suppression was also the site with earliest electrograms.

Conclusion

This case series illustrates phenomenon of mechanical suppression of PVCs as an indication for good site for successful ablation in unique veteran patient population.

Novel electrocardiographic criteria for diagnosis of premature ventricular complexes arising from the base of left ventricle

PURPOSE

We report new electrocardiographic criteria (ECG) for localizing premature ventricular complexes (PVCs) originating from the base of the left ventricle (LV).

METHODS

QRS deflection (positive negative or negative positive) in lead aVR and aVL respectively, were evaluated in 41 PVC/VT cases.

RESULTS

There were a total of 41 patients, age 64 ± 11 years. Twelve patients had QRS deflection in aVR which were completely opposite to the deflection in aVL. If the PVC originated from basal septum, aVR was negative while aVL positive and vice versa when it was from the baso-lateral LV. PVCs from other LV sites had aVR and aVL deflection in the same direction. The ECG criteria had a sensitivity and specificity of 91% and 84%, respectively.

CONCLUSION

We propose a new ECG criterion to localize PVCs originating from the base of the LV.