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Peters CJ, Marchlinski FE. Left Ventricular Summit Arrhythmias: Have We Reached the Peak of Ablation Success or Just a Higher Plateau? Circ Arrhythm Electrophysiol 2024; 17:e012969. [PMID: 38716652 DOI: 10.1161/circep.124.012969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Carli J Peters
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
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2
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Li C, Gu H, Liu C, Li K, Gao X, Yu M, Guo Z. Zero x-rays radiofrequency catheter ablation for ventricular premature contraction originating from the left coronary cusp during pregnancy: a case report. Front Cardiovasc Med 2023; 10:1183787. [PMID: 37745096 PMCID: PMC10514521 DOI: 10.3389/fcvm.2023.1183787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Pregnancy predisposes to arrhythmias in females due to physiological changes in the cardiovascular system, enhanced activity of the sympathetic nervous system (SNS), and changes in the endocrine system, regardless of whether there exist cardiovascular diseases before the pregnancy. Tachyarrhythmias may present for the first time or worsen persistently during pregnancy, potentially leading to maternal heart failure and sudden death, as well as some adverse fetal outcomes such as growth restriction, distress, premature birth, and stillbirth. Radiofrequency ablation (RFA) is one of the most important therapeutic methods for tachyarrhythmias. According to the 2019 European Society of Cardiology (ESC) guidelines, RFA in pregnant women should preferably be performed without x-rays. Since the 2000s, 3D mapping technique has rapidly developed, laying the foundation for cardiac electrophysiology examination free from x-rays. Ventricular arrhythmia originating from the left coronary cusp (LCC) is not common in clinic. RFA is challenging in the treatment of this type of disease due to the anatomical feature that the opening of the left main coronary artery is localized in the LCC.
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Affiliation(s)
| | | | | | | | | | - Manli Yu
- Department of Cardiovascular Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhifu Guo
- Department of Cardiovascular Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
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3
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Romero J, Gamero M, Alviz I, Grushko M, Diaz JC, Lorente M, Gabr M, Toquica CC, Krishnan S, Velasco A, Lin A, Natale A, Zou F, Di Biase L. Catheter Ablation of Left Ventricular Summit Arrhythmias from Adjacent Anatomic Vantage Points. Card Electrophysiol Clin 2023; 15:31-37. [PMID: 36774134 DOI: 10.1016/j.ccep.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Idiopathic ventricular arrhythmias (VA), particularly left ventricular outflow tract (LVOT) VA accounts for up to 10% of all VAs referred for ablative therapy. In addition to being infrequent, its intricate anatomy and its pathophysiology make catheter ablation (CA) of these arrhythmias a challenge even for experts. In this scenario, detailed right ventricular outflow tract as well as LVOT electroanatomic mapping including epicardial mapping are essential. In this article, we will emphasize our approach toward the CA technique used for LVOT VA, particularly IVS and/or LVS VA originating from intramural foci, along with its acute and long-term efficacy and safety.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Gamero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Carlos Diaz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marta Lorente
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Suraj Krishnan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aung Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Fengwei Zou
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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4
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Chung FP, Lin CY, Shirai Y, Futyma P, Santangeli P, Lin YJ, Chang SL, Lo LW, Hu YF, Chang HY, Marchlinski FE, Chen SA. Outcomes of catheter ablation of ventricular arrhythmia originating from the left ventricular summit: A multicenter study. Heart Rhythm 2020; 17:1077-1083. [DOI: 10.1016/j.hrthm.2020.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
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Di Biase L, Romero J, Zado ES, Diaz JC, Gianni C, Hranitzki PM, Sanchez JE, Mohanty S, Al-Ahmad A, Mohanty P, Trivedi C, Della Rocca D, Santangeli P, Burkhardt JD, Garcia FC, Marchlinski FE, Natale A. Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. Heart Rhythm 2019; 16:724-732. [DOI: 10.1016/j.hrthm.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Indexed: 10/27/2022]
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8
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Romero J, Ajijola O, Shivkumar K, Tung R. Characterization of Aortic Valve Closure Artifact During Outflow Tract Mapping. Circ Arrhythm Electrophysiol 2017. [DOI: 10.1161/circep.116.004845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jorge Romero
- From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA (J.R., O.A., K.S., R.T.); and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R.)
| | - Olujimi Ajijola
- From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA (J.R., O.A., K.S., R.T.); and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R.)
| | - Kalyanam Shivkumar
- From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA (J.R., O.A., K.S., R.T.); and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R.)
| | - Roderick Tung
- From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA (J.R., O.A., K.S., R.T.); and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R.)
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Kumar S, Tedrow UB, Stevenson WG. Ventricular Arrhythmias from the Left Ventricular Summit: Critical Importance of Anatomy, Imaging, and Detailed Mapping to Allow Safe and Effective Ablation. Card Electrophysiol Clin 2016; 8:89-98. [PMID: 26920176 DOI: 10.1016/j.ccep.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ventricular arrhythmias arising from the region of the left ventricular summit can be challenging for catheter-based percutaneous ablation. A detailed knowledge of the anatomy of this region and the need of high-density mapping of surrounding structures are critical in ensuring safe and effective ablation. This case-based review focuses on the particular challenges with ablation in this region.
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Affiliation(s)
- Saurabh Kumar
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Usha B Tedrow
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - William G Stevenson
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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10
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Lin CY, Chung FP, Lin YJ, Chong E, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chang YT, Chen YY, Chen CK, Chiou CW, Chen SA, Tsao HM. Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: Electrocardiographic characteristics and correlative anatomy. Heart Rhythm 2015; 13:111-21. [PMID: 26304712 DOI: 10.1016/j.hrthm.2015.08.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge. OBJECTIVES The objectives of this study were to investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and to develop an algorithm for predicting the successful ablation site. METHODS We recruited 66 patients (mean age, 47 ± 15 years; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and the LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n = 20; group 2: subvalvular region, n = 15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n = 16; group 4: epicardium requiring pericardial access, n = 15). The QRS morphological characteristics of VAs were compared between the 4 groups. RESULTS Electrocardiographic analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cutoff values of ≤1.415, 1.416-1.535, 1.536-1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated with the distance between the successful ablation site and the tip of the LV summit. A distance of >18.9 mm and an LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight patients (12.1%) developed VA recurrence during a mean follow-up of 15.9 months (interquartile range 9.2-24.2 months). CONCLUSION The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and the LV summit.
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Affiliation(s)
- Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Eric Chong
- Division of Cardiology, Department of Medicine, Alexandra Hospital, Jurong Health, Singapore
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chuen-Wang Chiou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | - Hsuan-Ming Tsao
- Division of Cardiology, National Yang-Ming University Hospital, I-Lan, Taiwan.
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Electrophysiological and electrocardiographic predictors of ventricular arrhythmias originating from the left ventricular outflow tract within and below the coronary sinus cusps. Clin Res Cardiol 2015; 104:544-54. [DOI: 10.1007/s00392-015-0817-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Hachiya H, Hirao K, Nakamura H, Taniguchi H, Miyazaki S, Komatsu Y, Kusa S, Takagi T, Iwasawa J, Ichihara N, Kuroi A, Hayashi T, Tanaka Y, Iesaka Y. Electrocardiographic Characteristics Differentiating Epicardial Outflow Tract-Ventricular Arrhythmias Originating From the Anterior Interventricular Vein and Distal Great Cardiac Vein. Circ J 2015; 79:2335-44. [DOI: 10.1253/circj.cj-15-0476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hitoshi Hachiya
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Hiroaki Nakamura
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Hiroshi Taniguchi
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Shinsuke Miyazaki
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Yuki Komatsu
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Shigeki Kusa
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Takamitsu Takagi
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Jin Iwasawa
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Noboru Ichihara
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Akio Kuroi
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Tatsuya Hayashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Yasuaki Tanaka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Yoshito Iesaka
- Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital
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Jauregui Abularach ME, Campos B, Park KM, Tschabrunn CM, Frankel DS, Park RE, Gerstenfeld EP, Mountantonakis S, Garcia FC, Dixit S, Tzou WS, Hutchinson MD, Lin D, Riley MP, Cooper JM, Bala R, Callans DJ, Marchlinski FE. Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart Rhythm 2012; 9:865-73. [DOI: 10.1016/j.hrthm.2012.01.022] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Indexed: 10/14/2022]
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14
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Affiliation(s)
- Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Sasaki T, Hachiya H, Hirao K, Higuchi K, Hayashi T, Furukawa T, Kawabata M, Takahashi A, Isobe M. Utility of distinctive local electrogram pattern and aortographic anatomical position in catheter manipulation at coronary cusps. J Cardiovasc Electrophysiol 2010; 22:521-9. [PMID: 21091969 DOI: 10.1111/j.1540-8167.2010.01957.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The coronary cusps have recently become target sites for radiofrequency catheter ablation of both outflow tract ventricular arrhythmias originating near the coronary cusps (CC-VA) and atrial tachyarrhythmias such as focal atrial tachycardia originating near the noncoronary cusp (NCC-AT). However, the relation between local electrograms recorded at each CC during sinus rhythm and their anatomical position as assessed by aortography has not yet been systematically described. METHODS AND RESULTS In 28 patients undergoing RFCA for CC-VA or NCC-AT, amplitudes of the atrial and ventricular potentials at the CCs were measured during sinus rhythm, and the atrial/ventricular (A/V) potential ratio was computed. Relative positions of the CCs were assessed by aortography in 2 X-ray projections. In the right (RCC) and left coronary cusps (LCC), amplitudes of the ventricular potential were larger than those of the atrial potential, leading to an A/V ratio <1 in all patients (0.08 ± 0.10, 0.32 ± 0.21, respectively). In contrast, in the NCC, the amplitude of the atrial potential was larger than the ventricular potential, leading to a higher A/V ratio relative to the CCs (5.7 ± 2.6, P < 0.0001). Aortography demonstrated the rightward and anterior location of the RCC, the leftward and superior location of the LCC, and the inferior and posterior location of the NCC. CONCLUSIONS Awareness of the distinctive local electrogram pattern of each CC and their positions on aortography should lead to safer and more effective catheter ablation at the CCs.
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Affiliation(s)
- Takeshi Sasaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
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Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Bella PD, Hindricks G, Jais P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 2009; 11:771-817. [DOI: 10.1093/europace/eup098] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dametto E, Proclemer A, Zardo F, Nicolosi GL. Double-exit transaortic sinus cusp ventricular tachycardia: An unusual form of idiopathic outflow tract tachycardia treated by radiofrequency catheter ablation. Heart Rhythm 2006; 3:1490-3. [DOI: 10.1016/j.hrthm.2006.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 08/22/2006] [Indexed: 11/15/2022]
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Kumagai K, Takahashi A, Yamauchi Y, Aonuma K. Ventricular Tachycardia Originating from the Epicardium Identified by Intracoronary Mapping Using a PTCA Guidewire. J Cardiovasc Electrophysiol 2006; 17:670-3. [PMID: 16836720 DOI: 10.1111/j.1540-8167.2006.00357.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case in which endocardial radiofrequency (RF) ablation guided by unipolar intracoronary mapping using a guidewire was an effective therapy for treating VT originating from an epicardial site of the left ventricle. A 55-year-old man with dilated cardiomyopathy was referred for treatment of refractory sustained monomorphic VT. The earliest unipolar electrogram with a near-perfect pace map was identified at segment #8 of the left anterior descending artery utilizing a guidewire through a microtube catheter during the VT. VT was terminated by an endocardial RF application at an upper midventricular septal site that did not have a good pacemap or the earliest electrogram, and that was the most adjacent anatomical endocardial site to the guidewire tip. No VT was clinically observed during a follow up period of 14 months.
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Affiliation(s)
- Koji Kumagai
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Machi, Sendai, Japan.
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Meininger GR, Berger RD. Idiopathic ventricular tachycardia originating in the great cardiac vein. Heart Rhythm 2006; 3:464-6. [PMID: 16567296 DOI: 10.1016/j.hrthm.2005.12.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Accepted: 12/23/2005] [Indexed: 11/21/2022]
Affiliation(s)
- Glenn R Meininger
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Hirasawa Y, Miyauchi Y, Iwasaki YK, Kobayashi Y. Successful Radiofrequency Catheter Ablation of Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein. J Cardiovasc Electrophysiol 2005; 16:1378-80. [PMID: 16403074 DOI: 10.1111/j.1540-8167.2005.00257.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a case of idiopathic left ventricular outflow tract (LVOT) tachycardia that was eliminated by a radiofrequency application from the anterior interventricular coronary vein (AIV). The ECG exhibited QRS complexes with an inferior axis and atypical left bundle branch block pattern with an early transition of the precordial R waves at V3. Several radiofrequency applications from the coronary cusps and endocardial LVOT were not effective. Radiofrequency applications in the AIV, where the activation preceded the onset of the QRS by 30 msec, successfully eliminated the tachycardia. The AIV may be an optional site for radiofrequency ablation of idiopathic epicardial LVOT tachycardia.
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Affiliation(s)
- Yasuhiro Hirasawa
- First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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HIRASAWA YASUHIRO, MIYAUCHI YASUSHI, IWASAKI YUKI, KOBAYASHI YOSHINORI. Successful Radiofrequency Catheter Ablation of Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein. J Cardiovasc Electrophysiol 2005. [DOI: 10.1111/j.1540-8167.2005.50164.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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