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Heeger CH, Tilz RR. [Ventricular tachycardia-without structural heart disease: History]. Herzschrittmacherther Elektrophysiol 2024; 35:102-109. [PMID: 38407580 PMCID: PMC10923990 DOI: 10.1007/s00399-024-01007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
This article focuses on ventricular arrythmias without evidence for structural heart disease. There are many different reasons for this type of arrythmia and there is still a gap of knowledge. Starting with the first description of this disease, we present the diagnosis and management with medication, and finally catheter ablation procedures from the beginning to how it is currently treated and how it possibly will be treated in the near future.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department für Rhythmologie, Abteilung für Kardiologie & Internistische Intensivmedizin, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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2
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Idiopathic Ventricular Tachycardia. J Clin Med 2023; 12:jcm12030930. [PMID: 36769578 PMCID: PMC9918172 DOI: 10.3390/jcm12030930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band.
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3
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Trends in Successful Ablation Sites and Outcomes of Ablation for Idiopathic Outflow Tract Ventricular Arrhythmias. JACC Clin Electrophysiol 2020; 6:221-230. [DOI: 10.1016/j.jacep.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022]
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4
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Yakubov A, Salayev O, Hamrayev R, Sultankhonov S. A case of successful ablation of ventricular tachycardia focus in the left ventricular summit through the left atrial appendage: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty110. [PMID: 31020186 PMCID: PMC6426030 DOI: 10.1093/ehjcr/yty110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/17/2018] [Indexed: 11/14/2022]
Abstract
Background Although premature ventricular complexes and ventricular tachycardia (VT) from outflow tracts are easy to map and ablate, some foci create the greatest challenges for the electrophysiologist. One such example is the 'Bermuda triangle' of the heart. Case summary In this article, we describe the rarely used but acceptable approach to the 'Bermudian' focus. We present a case of a 38-year-old male patient with sustained monomorphic VT, who underwent radiofrequency ablation of arrhythmogenic myocardium. After unsuccessful ablation through the posterior right ventricular outflow tract (RVOT), left coronary cusp (LCC), and distal coronary sinus, tachycardia was eliminated from the left atrial appendage (LAA). Complaints such as palpitations and weakness disappeared after the procedure. Discussion Radiofrequency ablation of VT might be performed using LAA. This approach is used when the epicardial location of arrhythmia-causing tissue is suspected and ablation through the RVOT, LCC, and great cardiac vein fails.
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Affiliation(s)
- Akmal Yakubov
- Department of Electrophysiology, Republican Scientific Centre of Cardiology, Yunus Abad, 19 District, 19th Building, 23 Apt., Tashkent, Uzbekistan
| | - Oybek Salayev
- Department of Electrophysiology, Republican Scientific Centre of Cardiology, Yunus Abad, 19 District, 19th Building, 23 Apt., Tashkent, Uzbekistan
| | - Ramesh Hamrayev
- Department of Electrophysiology, Republican Scientific Centre of Cardiology, Yunus Abad, 19 District, 19th Building, 23 Apt., Tashkent, Uzbekistan
| | - Sardorkhon Sultankhonov
- Department of Electrophysiology, Republican Scientific Centre of Cardiology, Yunus Abad, 19 District, 19th Building, 23 Apt., Tashkent, Uzbekistan
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Anderson RH, Mohun TJ, Sánchez-Quintana D, Mori S, Spicer DE, Cheung JW, Lerman BB. The anatomic substrates for outflow tract arrhythmias. Heart Rhythm 2019; 16:290-297. [DOI: 10.1016/j.hrthm.2018.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 12/13/2022]
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Xie HY, Liang JJ, Ma J. Ablation of ventricular arrhythmias with predominant monophasic "R" waves in precordial leads from the left sinus of Valsalva: Electrocardiographic and electrophysiologic characteristics. J Cardiovasc Electrophysiol 2019; 30:541-549. [PMID: 30661263 DOI: 10.1111/jce.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND While the left sinus of Valsalva (LSV) is a frequent origin of ventricular arrhythmias (VAs). Uncommonly, VAs with right bundle branch block (RBBB) morphology may be successfully terminated from the LSV. OBJECTIVE We aimed to investigate the electrocardiographic and electrophysiologic characteristics of VAs with RBBB which were successfully eliminated from the LSV. METHODS We identified patients with VAs successfully ablated from the LSV from January 2014 to December 2017 and compared electrophysiologic characteristics and ablation sites of those VAs with RBBB versus a control group of patients with left bundle branch block morphology. RESULTS We identified 18 patients with RBBB and predominant "R" waves in the precordial leads. In 12 (66.7%) patients, a small "s" wave in lead V2 and positive "R" in the remaining pericardial leads could be seen. Overall, a single "V" potential was seen in 72.2% of patients in the study group, while discrete potentials were recorded in 80% of the patients in the control group. The majority (88.9%) of the VAs could only be terminated at the nadir of the LSV in the study group. After mean follow-up of 33 ± 14 months, 93.8% and 92% were free of VAs after initial ablation in study and control group, respectively (P = 0.99). CONCLUSION Some VAs with predominant monophasic "R" wave in precordial leads could be terminated from LSV, especially a small "s" wave in lead V2 was recorded. The nadir of LSV is highly successful for RBBB VAs and single electrogram was recorded at the target for most of the cases.
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Affiliation(s)
- Jian-du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, an affiliate of Capital Medical University, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Low power ablation for left coronary cusp ventricular tachycardia-Efficacy and long-term outcome. Indian Heart J 2019; 70 Suppl 3:S384-S388. [PMID: 30595294 PMCID: PMC6309714 DOI: 10.1016/j.ihj.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/30/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background The left coronary cusp is an uncommon but well-known site for the ablation of idiopathic ventricular tachycardia (VT). Proximity to the left coronary ostium makes ablation of this arrhythmia challenging. Different power settings have been described by various operators. Our objective was to describe the outcomes with low power ablation. Methods Once mapping confirmed origin from the left coronary cusp, ablation was performed if the best site was situated at least 5 mm from the left coronary ostium. Ablation was started at 15 W and, if successful, was stopped after 30 s. When required, higher powers were used up to 30 W. Results Ten patients with VT or premature ventricular beats mapped to the left coronary cusp were included in the study. No ablation was performed in one patient because of proximity to the left coronary ostium. Successful ablation was performed in eight of the other nine patients with a mean power of 18.1 ± 5.3 W and duration of 42.2 ± 13.5 s. There were no complications. All the eight patients remained free of recurrence at 16.8 ± 16.5 months of follow-up. Conclusions VT can be ablated from the left coronary cusp close to the left coronary ostium. Ablation with low power is effective in achieving immediate success which is also durable with time while avoiding complications.
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8
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Kajiyama T, Hachiya H, Iesaka Y. A case of ventricular ectopy eliminated by catheter ablation: Diversity of the potentials on the left coronary cusp. J Arrhythm 2018; 34:576-579. [PMID: 30327705 PMCID: PMC6174368 DOI: 10.1002/joa3.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/10/2018] [Indexed: 11/07/2022] Open
Abstract
An 18-year-old man without organic heart disease underwent catheter ablation for frequent monomorphic ventricular ectopic beats(VEBs). The origin of the VEB was presumed located on the left coronary cusp(LCC) regarding his electrocardiography. Local activation in the right ventricular outflow tract was not so early. On the LCC, four different prepotentials were obtained by slight relocation of the catheter. Finally, on the site with positive discrete prepotential recorded on the distal electrodes, an application of radiofrequency current immediately eliminated the VEB. Although LCC is considered as a small structure, detailed mapping may be important to find the most optimal ablation site.
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Affiliation(s)
| | - Hitoshi Hachiya
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraIbarakiJapan
| | - Yoshito Iesaka
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraIbarakiJapan
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9
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Liu Z, Liu X, Ren L, Yin X, Han H, Wang Y, Deng W, Jia Y, Fang P, Yang X. Recurrence after successful catheter ablation for ventricular arrhythmia from the aortic root. Acta Cardiol 2018; 73:29-39. [PMID: 28691870 DOI: 10.1080/00015385.2017.1324658] [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: 10/19/2022]
Abstract
OBJECTIVE The mechanism underlying recurrence after successful ablation of ventricular arrhythmias (VAs) was unclear. Spectrum analysis can help to identify near-field activation. The purpose of this study was to quantify the changes of near-field activation in response to ablation at the VAs origin in the aortic root (AR-VAs) and to assess its relationship with late ablation outcome. METHODS AND RESULTS Patients who underwent acutely successful ablation for AR-VAs were analysed. Ventricular electrograms acquired before and after ablation at VAs origin were subjected to spectrum analysis. The area under the curve of the high frequency component (HFC, 50-200 Hz) and the low frequency component (LFC, 0-50 Hz) was measured. The proportion of HFC to the frequency spectrum of 0-200 Hz was defined as the HFC ratio (HFCR). The reduction of HFC and HFCR in response to ablation was defined as HFC pre-post and HFCR pre-post, respectively. Documentation of VAs with the same morphology after an acute successful procedure was defined as recurrence. Fifty-six patients were analysed, and VAs recurred in 17 patients. HFCR pre-post, HFC pre-post, and HFC pre-ablation were significantly higher in patients without recurrence. And HFCR pre-post has the highest predictive value (area under the receiver-operating characteristic curve: 0.975). A HFCR pre-post of 1.0% differentiated two groups (sensitivity = 84.6%, specificity = 100%). Higher HFCR pre-post was correlated with shorter VAs termination time (correlation coefficient = -0.399, p = .009). CONCLUSIONS HFCR pre-post can quantify the near-field activation change during ablation. Incomplete destruction to the VAs foci could underlie recurrence after successful ablation.
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Affiliation(s)
- Zheng Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoqin Liu
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University, Beijing, People’s Republic of China
| | - Lan Ren
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University, Beijing, People’s Republic of China
| | - Xiandong Yin
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Han
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University, Beijing, People’s Republic of China
| | - Yuxin Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenning Deng
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuhe Jia
- Arrhythmia Center, Fuwai Hospital, Beijing, People’s Republic of China
| | - Pihua Fang
- Arrhythmia Center, Fuwai Hospital, Beijing, People’s Republic of China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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ROCA-LUQUE IVO, RIVAS NURIA, FRANCISCO JAUME, PEREZ JORDI, ACOSTA GABRIEL, ORISTRELL GERARD, TERRICABRES MARIA, GARCIA-DORADO DAVID, MOYA ANGEL. Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps. J Cardiovasc Electrophysiol 2016; 28:126-131. [PMID: 27759948 DOI: 10.1111/jce.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | - NURIA RIVAS
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - JORDI PEREZ
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - GERARD ORISTRELL
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - MARIA TERRICABRES
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - ANGEL MOYA
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
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WANG YUBIN, MA JUAN, DONG JIANZENG, BAI RONG, WANG JING, LI SONGNAN, YU RONGHUI, LONG DEYONG, MA CHANGSHENG, CHU JIANMIN. Catheter Ablation of Premature Ventricular Contractions Originating in the Aortic Sinus Cusp or Great Cardiac Vein: Two QRS Morphologies with One Origin. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1029-38. [PMID: 25953101 DOI: 10.1111/pace.12652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/30/2015] [Accepted: 04/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - JUAN MA
- Weifang Medical University; Weifang China
| | - JIAN-ZENG DONG
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - RONG BAI
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - JING WANG
- FuWai Hospital, National Center for Cardiovascular Diseases of China; Beijing China
| | - SONG-NAN LI
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - RONG-HUI YU
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - DE-YONG LONG
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - CHANG-SHENG MA
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - JIAN-MIN CHU
- FuWai Hospital, National Center for Cardiovascular Diseases of China; Beijing China
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12
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Liu E, Xu G, Liu T, Ye L, Zhang Q, Zhao Y, Li G. Discrete potentials guided radiofrequency ablation for idiopathic outflow tract ventricular arrhythmias. Europace 2015; 17:453-460. [PMID: 25179648 DOI: 10.1093/europace/euu184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
AIMS Discrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs). METHODS AND RESULTS Seventeen consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation were included. Intracardiac electrograms during the mapping and ablation were analysed. During sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude 0.51 ± 0.21 mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram during the arrhythmias was noted. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, lower unipolar and bipolar ventricular voltage of sinus beats were noted compared with the adjacent regions without DPs (unipolar: 6.1 ± 1.8 vs. 8.3 ± 2.3 mV, P < 0.05; bipolar: 0.62 ± 0.45 vs. 1.03 ± 0.60 mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls. CONCLUSION Discrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy will help to reduce the recurrence of idiopathic outflow tract arrhythmias.
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Affiliation(s)
- Enzhao Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Gang Xu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Lan Ye
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Qitong Zhang
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Yanshu Zhao
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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14
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Francis J. Left Ventricular Outflow Tract Tachycardias. Indian Pacing Electrophysiol J 2013; 13:1-3. [PMID: 23329869 PMCID: PMC3539396 DOI: 10.1016/s0972-6292(16)30583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Les tachycardies ventriculaires épicardiques. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2011. [DOI: 10.1016/s1878-6480(11)70392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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NAKANO EMI, HARADA TOMOO, AONUMA KAZUTAKA, SOEJIMA KYOKO, WAKIMOTO HIROFUMI, MATSUMOTO NAOKI, MIYAKE FUMIHIKO. Identification of Unusual Reentry Circuit Sites of Nonischemic Ventricular Outflow Tract Tachycardia. J Cardiovasc Electrophysiol 2011; 23:179-87. [DOI: 10.1111/j.1540-8167.2011.02149.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Fukuhara J, Sumitomo N, Nakamura T, Ichikawa R, Matsumura M, Abe O, Miyashita M, Taniguchi K, Kanamaru H, Ayusawa M, Karasawa K, Mugishima H. Electrophysiological Characteristics of Idiopathic Ventricular Tachycardia in Children. Circ J 2011; 75:672-6. [DOI: 10.1253/circj.cj-10-0339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Junji Fukuhara
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Naokata Sumitomo
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Takahiro Nakamura
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Rie Ichikawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Masaharu Matsumura
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Osamu Abe
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Michio Miyashita
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Kazuo Taniguchi
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Hiroshi Kanamaru
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Kensuke Karasawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
| | - Hideo Mugishima
- Department of Pediatrics and Child Health, Nihon University, School of Medicine
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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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Bala R, Garcia FC, Hutchinson MD, Gerstenfeld EP, Dhruvakumar S, Dixit S, Cooper JM, Lin D, Harding J, Riley MP, Zado E, Callans DJ, Marchlinski FE. Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm 2010; 7:312-22. [DOI: 10.1016/j.hrthm.2009.11.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
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Neiger JS, Gupta A, Halleran SM, Trohman RG. Magnesium sensitive, adenosine resistant, repetitive monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2009; 32:e28-30. [PMID: 19744277 DOI: 10.1111/j.1540-8159.2009.02527.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Repetitive monomorphic ventricular tachycardia (RMVT) is characterized by episodes of ventricular ectopy and nonsustained VT exacerbated by catecholamines. Because this arrhythmia is frequently adenosine sensitive, its mechanism is believed to be cyclic adenosine monophosphate-mediated triggered activity due to delayed afterdepolarizations. We present a case of RMVT associated with significant hypomagnesemia (serum level = 1.1 mg/dL), which did not respond to intravenous (IV) adenosine and terminated repeatedly after IV magnesium. Electrophysiologic study demonstrated an origin from the left sinus of Valsalva, which was successfully ablated. The combination of adenosine resistance and magnesium sensitivity may be consistent with an atypical RMVT mechanism related to inhibition of sodium-potassium adenosine triphosphatase (Na(+)-K(+) ATPase).
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Affiliation(s)
- Jeffrey S Neiger
- Department of Medicine, Section of Cardiology, Clinical Cardiac Electrophysiology Service, Rush University Medical Center, Chicago, Illinois, USA
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21
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Improvement of cardiac function and neurological remodeling in a patient with tachycardia-induced cardiomyopathy after catheter ablation. J Cardiol 2009; 54:134-8. [DOI: 10.1016/j.jjcc.2008.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/16/2008] [Accepted: 10/03/2008] [Indexed: 11/21/2022]
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Reversible cardiomyopathy provoked by focal ventricular arrhythmia originating from the base of the posterior papillary muscle. J Interv Card Electrophysiol 2009; 25:67-72. [DOI: 10.1007/s10840-008-9341-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
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Catheter ablation of an incessant ventricular tachycardia originating from the left aortic sinus cusp in an adolescent with subacute myocarditis. Clin Res Cardiol 2008; 98:66-70. [DOI: 10.1007/s00392-008-0717-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 09/03/2008] [Indexed: 10/21/2022]
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Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Brasch M, Jung W. Catheter ablation within the sinus of Valsalva--a safe and effective approach for treatment of atrial and ventricular tachycardias. Heart Rhythm 2008; 5:1265-72. [PMID: 18774100 DOI: 10.1016/j.hrthm.2008.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 06/07/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ablation of the aortic sinus of Valsalva in adults for ectopic atrial tachycardia (EAT) and ventricular tachycardia (VT)/premature ventricular complexes (PVCs) has been reported in only a very few patients. Limited data exist concerning the safety of aortic ablation. OBJECTIVE The purpose of this study was to confirm aortic wall and aortic valve integrity after ablation and to evaluate for potential cerebral embolism due to thrombus formation at aortic wall lesions. METHODS From January 2006 to August 2007, 21 patients with EAT (n = 6) or VT/PVCs (n = 15) originating from the sinus of Valsalva underwent successful ablation. The aortic wall structure was evaluated using transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) the day after ablation and at 6-month follow-up for all patients. To rule out cerebral embolism due to postablation thromboembolic events, a cerebral MRI was performed immediately after ablation in six patients and at 6-month follow-up in all patients. Ablation success was defined by 24-hour Holter monitoring before hospital discharge and after 6 months. RESULTS Aortic wall integrity was confirmed in all patients by TEE and MRI. Cerebral MRI showed evidence of silent cerebral ischemia in one patient. Aortic valve thickening was detected in one patient by TEE. CONCLUSION Ablation in the aortic sinus of Valsalva is a safe and effective approach for atrial tachycardia or VT/PVCs. The incidence of silent ischemia needs further evaluation.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg, Germany.
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Lamberti F, Nardo R, Calò L, Loricchio ML, Lemme R, Maggi R, Gaspardone A. Catheter ablation of isolated premature ventricular contractions arising from the sinus of Valsalva. J Cardiovasc Med (Hagerstown) 2007; 8:732-7. [PMID: 17700408 DOI: 10.2459/01.jcm.0000285315.17692.b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Monomorphic premature ventricular contractions (PVCs) are a benign phenomenon in patients without structural heart disease. The focal source is usually localised in the right ventricular outflow tract and more rarely in the left ventricular outflow tract. We report two cases of frequent isolated PVCs treated with radiofrequency catheter ablation. Ventricular dysfunction was documented in one patient and the potential contribution of arrhythmia to ventricular dysfunction was suspected. In both patients electroanatomic mapping of the right and left ventricular outflow tracts was performed, which allowed identification of the earliest ventricular activation during PVCs. The site of the earliest ventricular activation was documented in both cases at the left coronary cusp of the aortic valve. Aortography was performed to disclose the relationship between the ablation catheter and the anatomic structure of the aortic root. PVCs were successfully eliminated with radiofrequency application in both patients.
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Bortone A, Combes N, Boveda S, Albenque JP. Dual tachycardias associating double-exit left aortic sinus cusp tachycardia with paroxysmal atrial fibrillation: evidence of a link between both arrhythmias by means of the autonomic nervous system. J Cardiovasc Electrophysiol 2007; 18:1334-7. [PMID: 17655674 DOI: 10.1111/j.1540-8167.2007.00888.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dual tachycardias associating paroxysmal atrial fibrillation (AF) with double-exit left aortic sinus cusp tachycardia (LASCT) are described for the first time in a patient referred for AF ablation. CASE Both tachycardias were successfully ablated under Carto-Merge guidance. Noteworthy, vagal denervation during AF ablation was responsible for an immediate decrease in LASCT occurrence and inducibility. CONCLUSION This case highlights the critical role that the autonomic nervous system plays within the cardiac arrhythmia framework.
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Affiliation(s)
- Agustín Bortone
- Electrophysiology and Pacing/Defibrillation Department, Clinique Pasteur, Toulouse, France
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Hasdemir C, Aktas S, Govsa F, Aktas EO, Kocak A, Bozkaya YT, Demirbas MI, Ulucan C, Ozdogan O, Kayikcioglu M, Can LH, Payzin S. Demonstration of Ventricular Myocardial Extensions into the Pulmonary Artery and Aorta Beyond the Ventriculo-Arterial Junction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:534-9. [PMID: 17437578 DOI: 10.1111/j.1540-8159.2007.00704.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A subgroup of outflow tract (OT) ventricular tachycardias (VT) originate from the aortic sinuses or the main stem of the pulmonary artery. The anatomic substrate for these tachycardias is unknown. The aim of this study was to investigate the presence of ventricular myocardial extensions (VME) into the pulmonary artery (PA) and aorta (Ao) beyond the ventriculo-arterial junction (VAJ) and determine the anatomical and histological characteristics of these muscle extensions. METHODS Ninety-five consecutive human hearts obtained at autopsy were studied. Longitudinal strips of tissue containing each cusp, aortic, and pulmonary artery walls and left and right ventricular outflow tracts were excised and histologically analyzed. Anatomical measurements, including length and thickness of VMEs, obtained at autopsy, were made. RESULTS VMEs beyond the VAJ were found in 21 of 95 (22%) patients studied. VMEs were found in 16 of 95 PAs (17%) and 7 of 95 Aos (7%) were examined. VMEs were located within the adventitia in 23 (88%) and on the epicardial surface in three (12%). The majority of VMEs were in continuity with the underlying ventricular OT muscle tissue. Myocellular hypertrophy and fibrosis were present in 19 (73%) and fatty tissue between the layers of VME in 18 (69%). Clinical data were available in 14 of 21 patients with positive VME. None of the patients (clinical data available group) had history of cardiac disease or signs or symptoms (palpitations or syncope) of cardiac disease. CONCLUSIONS VMEs into the PA and Ao beyond the VAJ are relatively common. It seems that their mere presence does not predispose to OT VTs. There are probably intrinsic arrhythmogenic properties in tissues specific to these regions in those patients who develop OT VTs.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
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Lewalter T, Schwab JO, Nickenig G. [Ventricular tachycardia. Diagnostic spectrum and therapeutic measures]. Internist (Berl) 2007; 47:1001-4, 1006-8, 1010-2. [PMID: 16969671 DOI: 10.1007/s00108-006-1708-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The origin of ventricular tachycardia lies in the ventricular tissue and includes a variety of symptoms such as monomorphic and polymorphic ventricular tachyarrhythmia (VT), ventricular flutter and ventricular fibrillation. Due to transitions of one form of VT to another, any form of VT incurs in principal the risk of cardiac failure. Apart from different electrophysiologic mechanisms such as reentry or triggered activity, any occurrence of VT has to be considered in an individual context: VT can be caused by structural heart disease such as coronary artery disease or dilative cardiomyopathy, or primary electrical disease such as long or short QT syndromes or can even occur without any detectable cause (idiopathic VT). Correct identification of the underlying cause of the arrhythmia is essential for the prognosis, differential therapy and long-term treatment of patients.
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Affiliation(s)
- T Lewalter
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
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Abstract
Idiopathic ventricular tachycardia (VT) is an uncommon form of VT that is seen in patients without structural heart disease. It is commonly seen in young patients and usually has a benign course. Recent studies have delineated the mechanisms and anatomical locations of this form of VT. Recognition of various forms of idiopathic VT based on characteristic QRS morphology from the 12-lead electrocardiogram (ECG) has important prognostic and therapeutic implications. The understanding of the mechanisms of idiopathic VT has led to the use of specific antiarrhythmic drugs targeting particular arrhythmias. Recent technological advances in the field of mapping and catheter ablation have led to a suitable alternative to drug therapy with a very high cure rate. This review describes the clinical features, ECG recognition, and management of idiopathic monomorphic VT.
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30
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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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d'Avila A, Thiagalingam A, Holmvang G, Houghtaling C, Ruskin JN, Reddy VY. What is the most appropriate energy source for aortic cusp ablation? A comparison of standard RF, cooled-tip RF and cryothermal ablation. J Interv Card Electrophysiol 2006; 16:31-8. [PMID: 17029021 DOI: 10.1007/s10840-006-9006-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Certain tachycardias can be eliminated by catheter ablation from within the base of the aortic valve (AV) cusps but the high blood flow and proximity to the coronary arteries create unique challenges. Standard radiofrequency (RF) energy, cooled-tip RF energy or cryothermal energy were compared to determine the optimal ablation modality. MATERIALS AND METHODS Experiments were conducted using adult swine or goats (15 animals). Ablation lesions were placed using either: temperature-controlled RF (4 mm-tip catheter; 60 degrees C/60 s), cooled-tip RF (4 mm-tip catheter with internal saline circulation at 0.6 ml/s; 40 degrees C/60 s), or cryoablation (6 mm-tip spot cryocatheter; <-75 degrees C/4 min). Animals were sacrificed 1 h after the last application and lesions were subject to pathological analysis. RESULTS Standard RF and cryoablation created similar depth lesions in the right coronary cusp (4.2+/-1.3 and 3.4+/-0.5 mm, respectively) but cryoablation was unable to create any visible lesions in the non-coronary cusp. Cooled tip ablation created larger ablation lesions in the right coronary cusp (5.25+/-0.5) and fully transmural left atrial ablation lesions after ablation in the noncoronary cusp. Acute damage to the cusps was not noted with any ablation modality. Disruption of elastic fibers in the aortic media was seen after standard and cooled tip radiofrequency ablation but not cryoablation. CONCLUSION Cryoablation within the AV cusps created similar sized lesions to standard RF ablation without evidence of elastic fibre disruption and may therefore be an appropriate first line ablation modality. Cooled-tip ablation created larger ablation lesions and therefore may be required if cryoablation is ineffective.
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Affiliation(s)
- Andre d'Avila
- Cardiac Arrhythmia Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street/GRB 109, Boston, MA 02114, USA
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Iwai S, Cantillon DJ, Kim RJ, Markowitz SM, Mittal S, Stein KM, Shah BK, Yarlagadda RK, Cheung JW, Tan VR, Lerman BB. Right and Left Ventricular Outflow Tract Tachycardias: Evidence for a Common Electrophysiologic Mechanism. J Cardiovasc Electrophysiol 2006; 17:1052-8. [PMID: 16800855 DOI: 10.1111/j.1540-8167.2006.00539.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION "Idiopathic" ventricular arrhythmias most often arise from the right ventricular outflow tract (RVOT), although arrhythmias from the left ventricular outflow tract (LVOT) are also observed. While previous work has elucidated the mechanism and electropharmacologic profile of RVOT arrhythmias, it is unclear whether those from the LVOT share these properties. The purpose of this study was to characterize the electropharmacologic properties of RVOT and LVOT arrhythmias. METHODS AND RESULTS One hundred twenty-two consecutive patients (61 male; 50.9 +/- 15.2 years) with outflow tract arrhythmias comprise this series, 100 (82%) with an RVOT origin, and 22 (18%) with an LVOT origin. The index arrhythmia was similar: sustained ventricular tachycardia (VT) (RVOT = 28%, LVOT = 36%), nonsustained VT (RVOT = 40%, LVOT = 23%), and premature ventricular complexes (RVOT = 32%, LVOT = 41%) (P = 0.32). Cardiac magnetic resonance imaging and microvolt T-wave alternans results (normal/indeterminate) were also comparable. In addition, 41% with RVOT foci and 50% with LVOT foci were inducible for sustained VT (P = 0.48), and induction of VT was catecholamine dependent in a majority of patients in both groups (66% and 73%; RVOT and LVOT, respectively; P = 1.0). VT was sensitive to adenosine (88% and 78% in the RVOT and LVOT groups, respectively, P = 0.59) as well as blockade of the slow-inward calcium current (RVOT = 70%, LVOT = 80%; P = 1.00) in both groups. CONCLUSIONS Electrophysiologic and pharmacologic properties, including sensitivity to adenosine, are similar for RVOT and LVOT arrhythmias. Despite disparate sites of origin, these data suggest a common arrhythmogenic mechanism, consistent with cyclic AMP-mediated triggered activity. Based on these similarities, these arrhythmias should be considered as a single entity, and classified together as "outflow tract arrhythmias."
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Affiliation(s)
- Sei Iwai
- Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, NY 10021, USA
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Miyaji K, Nishizaki M, Ogawa T, Sugawara S, Fujii H, Ashikaga T, Yamawake N, Sakurada H, Hiraoka M. Idiopathic Premature Ventricular Contraction Originating from Left Epicardial Outflow Tract-Effects of Antiarrhythmic Drugs, Autonomic Provocation and Radiofrequency Catheter Ablation-. J Arrhythm 2006. [DOI: 10.4020/jhrs.22.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Idiopathic Premature Ventricular Contraction Originating from Left Epicardial Outflow Tract —Effects of Antiarrhythmic Drugs, Autonomic Provocation and Radiofrequency Catheter Ablation—. J Arrhythm 2006. [DOI: 10.1016/s1880-4276(06)80009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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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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Sekiguchi Y, Aonuma K, Takahashi A, Yamauchi Y, Hachiya H, Yokoyama Y, Iesaka Y, Isobe M. Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. J Am Coll Cardiol 2005; 45:887-95. [PMID: 15766825 DOI: 10.1016/j.jacc.2004.10.071] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 10/27/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We investigated the electrocardiographic (ECG) and electrophysiologic characteristics of ventricular tachycardia (VT) originating within the pulmonary artery (PA). BACKGROUND Radiofrequency catheter ablation (RFCA) is routinely applied to the endocardial surface of the right ventricular outflow tract (RVOT) in patients with idiopathic VT of left bundle branch block morphology. It was recently reported that this arrhythmia may originate within the PA. METHODS Activation mapping and ECG analysis were performed in 24 patients whose VTs or ventricular premature contractions (VPCs) were successfully ablated within the PA (PA group) and in 48 patients whose VTs or VPCs were successfully ablated from the endocardial surface of the RVOT (RV-end-OT group). RESULTS R-wave amplitudes on inferior ECG leads, aVL/aVR ratio of Q-wave amplitude, and R/S ratio on lead V(2) were significantly larger in the PA group than in the RV-end-OT group. On intracardiac electrograms, atrial potentials were more frequently recorded in the PA group than in the RV-end-OT group (58% vs. 12%; p < 0.01). The amplitude of local ventricular potentials recorded during sinus rhythm within the PA was significantly lower than that recorded from the RV-end-OT (0.62 +/- 0.56 mV vs. 1.55 +/- 0.88 mV; p < 0.01). CONCLUSIONS Ventricular tachycardia originating within the PA has different electrocardiographic and electrophysiologic characteristics from that originating from the RV-end-OT. When mapping the RVOT area, the catheter may be located within the PA if a low-voltage atrial or local ventricular potential of <1-mV amplitude is recorded. Heightened attention must be paid if RFCA is required within the PA.
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Affiliation(s)
- Yukio Sekiguchi
- Cardiovascular Center, Yokosuka Kyosai General Hospital, Kanagawa, Japan.
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Tada H, Naito S, Ito S, Kurosaki K, Ueda M, Shinbo G, Hoshizaki H, Oshima S, Taniguchi K, Nogami A. Significance of Two Potentials for Predicting Successful Catheter Ablation From the Left Sinus of Valsalva for Left Ventricular Epicardial Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1053-9. [PMID: 15305952 DOI: 10.1111/j.1540-8159.2004.00584.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to identify the characteristics of electrograms that may be helpful in predicting successful ablation of idiopathic ventricular tachycardia from the aortic sinus of Valsalva. Data were obtained from 23 patients with symptomatic ventricular tachycardia or premature ventricular contractions (LV-VT) who underwent RF catheter ablation from the left sinus of Valsalva. Electrograms before and after application of RF energy during sinus rhythm and during LV-VT were analyzed. Complete elimination of LV-VT was finally achieved in 21 (91%) patients. The incidence of presystolic potentials preceding the QRS complex of LV-VT (P1 potential) was 90% for the 21 successful ablation sites, which did not differ from the incidence for the 24 unsuccessful sites (79%; P = 0.5). During sinus rhythm, a potential following the QRS complex (P2 potential) was more often recorded at the successful ablation site than at an unsuccessful ablation site before and after application of RF energy (before, P < 0.05; after, P < 0.001). The appearance of the P2 potential or a delay in the preexisting P2 potential after application of RF energy was observed only at the successful ablation sites (P < 0.001). In 18 control individuals who had no LV-VT, no P2 potential was recorded within the left sinus of Valsalva. Although the P1 potential may be useful for identifying the successful ablation site, its sensitivity is low. The appearance of the P2 potential or an increasingly delayed P2 potential after application of RF energy may be more useful than the P1 potential for predicting successful ablation.
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Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
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Soejima Y, Aonuma K, Iesaka Y, Isobe M. Ventricular Unipolar Potential in Radiofrequency Catheter Ablation of Idiopathic Non-Reentrant Ventricular Outflow Tachycardia. ACTA ACUST UNITED AC 2004; 45:749-60. [PMID: 15557716 DOI: 10.1536/jhj.45.749] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted this study to verify the efficacy of ventricular unipolar potential (V-uni) for ablation of idiopathic non-reentrant ventricular tachycardia (idio-VT). The morphology of V-uni at the successful and unsuccessful sites was analyzed in 27 patients with idio-VT [20 with right ventricular outflow tachycardia (RVOVT) and 7 with left ventricular outflow tachycardia (LVOVT)]. The usefulness of V-uni was compared with a pacemapping method and the V-QRS interval. The incidence of QS-pattern V-uni at the successful and best unsuccessful sites were 100 versus 25% (P = 0.000005) in RVOVT and 86 versus 29% (P = 0.10) in LVOVT. The pacemapping scores at the successful and best unsuccessful sites were 11.5/12 versus 11.2/12; NS in RVOVT, and 11.2/12 versus 11.1/12; NS in LVOVT. The mean V-QRS interval at the successful and the best unsuccessful sites were 22.5 +/- 3.8 versus 21.6 +/- 3.4 msec; NS in RVOVT, 15.1 +/- 3.2 versus 12.5 +/- 3.3 msec; NS in LVOVT. The sensitivity (sen) and specificity (spe) of QS-pattern V-uni to determine the optimum target sites were 1.0 and 0.89 in RVOVT and 0.86 and 0.83 in LVOVT, respectively. In the ablation of idio-VT, QS-pattern V-uni is simply and visually identifiable, is very useful, and should be given a high priority when determining the optimum target site.
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Affiliation(s)
- Yohkoh Soejima
- Department of Cardiology, Ohme Municipal General Hospital, Tokyo 198-0042, Japan
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Strobel JS. Electrocardiographic characteristics of ventricular arrhythmias arising from the aortic sinuses of valsalva: a case report and review of the literature. J Interv Card Electrophysiol 2002; 7:203-7. [PMID: 12510130 DOI: 10.1023/a:1021375628767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a patient with frequent, symptomatic, and drug-refractory premature ventricular contractions (PVCs) with a right bundle branch block, inferior axis morphology suggestive of a left ventricular outflow tract (LVOT) origin. Successful ablation of the PVCs was performed from the left coronary cusp of the aortic valve. We discuss our patient and review the literature regarding patients with ventricular arrhythmias arising from the coronary cusps, with special emphasis on the use of the electrocardiogram to aid localization of the focus.
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Affiliation(s)
- John S Strobel
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Sosa E, Scanavacca M, d'Avila A. Catheter ablation of the left ventricular outflow tract tachycardia from the left atrium. J Interv Card Electrophysiol 2002; 7:61-5. [PMID: 12391421 DOI: 10.1023/a:1020872216950] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
RF ablation of idiopathic left ventricular outflow tract ventricular tachycardia (LOT-VT) may imply in significant risk of damaging the proximal left main if RF pulses are being delivered from the left sinus of Valsalva or from inside an epicardial coronary vein. This report describes a new approach to control LOT-VT by means of RF catheter ablation.
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Affiliation(s)
- Eduardo Sosa
- Unidade Clinica de Arritmia, Heart Institute (InCor)-University of São Paulo Medical School, Brazil.
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Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, Burns M, Antz M, Ernst S, Cappato R, Kuck KH. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002; 39:500-8. [PMID: 11823089 DOI: 10.1016/s0735-1097(01)01767-3] [Citation(s) in RCA: 396] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to investigate the electrocardiographic (ECG) characteristics for guiding catheter ablation in patients with repetitive monomorphic ventricular tachycardia (RMVT) originating from the aortic sinus cusp (ASC). BACKGROUND Repetitive monomorphic ventricular tachycardia can originate from the right ventricular outflow tract (RVOT) and ASC in patients with a left bundle branch block (LBBB) morphology and an inferior axis. METHODS Activation mapping and ECG analysis was performed in 15 patients with RMVT or ventricular premature contractions. The left main coronary artery (LMCA) was cannulated as a marker and for protection during radiofrequency delivery if RMVT originated from the left coronary ASC. RESULTS During arrhythmia, the earliest ventricular activation was recorded from the superior septal RVOT in eight patients (group 1) and from the ASC in the remaining seven patients (group 2). The indexes of R-wave duration and R/S-wave amplitude were significantly lower in group 1 than in group 2 (31.8+/-13.5% vs. 58.3+/-12.1% and 14.9+/-9.9% vs. 56.7+/-29.5%, respectively; p < 0.01), despite similar QRS morphology. In five patients from group 2, RMVT originated from the left ASC, with a mean distance of 12.2+/-3.2 mm (range 7.3 to 16.1) below the ostium of the LMCA. In the remaining two patients, the RMVT origin was in the right ASC. All arrhythmias were successfully abolished. None of the patients had recurrence or complications during 9+/-3 months of follow-up. CONCLUSIONS On the surface ECG, RMVT from the ASC has a QRS morphology similar to that of RVOT arrhythmias. The indexes of R-wave duration and R/S-wave amplitude can be used to differentiate between the two origins. Radiofrequency ablation can be safely performed within the left ASC with a catheter cannulating the LMCA.
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Affiliation(s)
- Feifan Ouyang
- II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
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Tada H, Nogami A, Naito S, Fukazawa H, Horie Y, Kubota S, Okamoto Y, Hoshizaki H, Oshima S, Taniguchi K. Left ventricular epicardial outflow tract tachycardia: a new distinct subgroup of outflow tract tachycardia. JAPANESE CIRCULATION JOURNAL 2001; 65:723-30. [PMID: 11502049 DOI: 10.1253/jcj.65.723] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study investigated the incidence and ECG characteristics of ventricular tachycardias (VTs) originating from the left ventricular (LV) epicardium. Thirty-one consecutive patients with VT or premature ventricular contraction originating from the outflow tract (OT-VT) underwent catheter ablation. Twenty-one OT-VTs were ablated from the endocardium in the right ventricular (RV) OT and 3 were ablated from the endocardium in the LVOT. In the remaining 7 patients, 4 (13%) OT-VTs were LV epicardial in origin, and 1 of these was ablated from the left sinus of Valsalva. The ECG characteristics of OT-VT of epicardial origin included prominent tall R-waves in the inferior leads, an R-wave in V1 and an S-wave in V2, precordial R-wave transition in V2-4, a deep QS-wave in aVL, and no S-wave in V6. In addition, there was an atypical left bundle branch block morphology with an inferior axis. These findings were observed during pacing from several sites in the LV epicardium. Furthermore, pacing from the left sinus of Valsalva caused a relatively tall R in V1, deep S-wave in V2 and a tall R-wave with a shallow S-wave in V3, as well as tall R-waves in the inferior leads, which represented intermediate characteristics between RV endocardial OT-VT and LV endocardial OT-VT. In conclusion, OT-VT originating from the LV epicardium is not uncommon and has characteristic ECG findings. Some of them can be ablated from the left sinus of Valsalva.
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Affiliation(s)
- H Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
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Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S, Neibauer M, Saliba W, Chung M, Tchou P, Natale A. Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 2001; 37:1408-14. [PMID: 11300454 DOI: 10.1016/s0735-1097(01)01127-5] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe a normal heart left bundle branch block, inferior axis ventricular tachycardia (VT), that could not be ablated from the right or left ventricular outflow tracts. BACKGROUND Whether these VTs are epicardial and can be identified by a specific electrocardiographic pattern is unclear. METHODS Twelve patients with normal heart left bundle branch block, inferior axis VT and previously failed ablation were included in this study. Together with mapping in the right and left ventricular outflow tracts, we obtained percutaneous epicardial mapping in the first five patients and performed aortic sinus of Valsalva mapping in all patients. RESULTS No adequate pace mapping was observed in the right and left ventricular outflow tracts. Earliest ventricular activation was noted in the epicardium and the aortic cusps. All patients were successfully ablated from the aortic sinuses of Valsalva (95% CI 0% to 18%). The electrocardiographic pattern associated with this VT was left bundle branch block, inferior axis and early precordial transition with Rs or R in V2 or V3. Ventricular tachycardia from the left sinus had rS pattern in lead I, and VT from the noncoronary sinus had a notched R wave in lead I. None of the patients had complications and all remained arrhythmia-free at a mean follow-up of 8 +/- 2.6 months. CONCLUSIONS Normal heart VT with left bundle branch block, inferior axis and early precordial transition can be ablated in the majority of patients from either the left or the noncoronary aortic sinus of Valsalva.
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Affiliation(s)
- L Kanagaratnam
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA
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Fiala M, Heinc P, Lukl J. CATHETER ABLATION OF VENTRICULAR TACHYCARDIA - LONG-TERM RESULTS. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2000. [DOI: 10.5507/bp.2000.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
The majority of patients who present with ventricular tachycardia have underlying structural heart disease. However, there has been increasing appreciation of the existence of multiple forms of idiopathic ventricular tachycardia with distinct features and unique mechanisms. The most common form of idiopathic ventricular tachycardia originates from the right ventricular outflow tract, is characterized by sensitivity to adenosine, and appears to be due to cyclic AMP-mediated triggered activity. Other forms of idiopathic ventricular tachycardia include intrafascicular left ventricular tachycardia, due to reentry, which is sensitive to verapamil, and automatic, propranolol-sensitive ventricular tachycardia.
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Affiliation(s)
- S Iwai
- Department of Medicine, Division of Cardiology, The New York Hospital-Cornell University Medical Center, 525 East 68th Street, Starr 409, New York, NY 10021, USA
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Hachiya H, Aonuma K, Yamauchi Y, Harada T, Igawa M, Nogami A, Iesaka Y, Hiroe M, Marumo F. Electrocardiographic characteristics of left ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 2000; 23:1930-4. [PMID: 11139960 DOI: 10.1111/j.1540-8159.2000.tb07055.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Catheter ablation of idiopathic left ventricular outflow tract tachycardia (LVOT-VT) is rare because a safe ablation technique at this site has not been described, and serious complications may occur. This study compared the QRS morphology of LVOT-VT with that of idiopathic right ventricular outflow tract tachycardia. A comparison was made between the electrocardiographic characteristics of LVOT-VT originating from the supravalvular region of a coronary cusp (Supra-Ao group) with those of LVOT-VT originating from the infravalvular endocardial region of a coronary cusp of the aortic valve within the LV (Infra-Ao group). After precise mapping of the right ventricle, left ventricle, pulmonary artery, coronary cusps, and proximal portion of the anterior interventricular vein, there were 17 patients in whom VT was thought to be located at the LVOT by both activation and pace mapping. They were divided between a Supra-Ao group (n = 8), and an Infra-Ao group (n = 9). Analysis of the 12-lead electrocardiogram (ECG) revealed an S wave in lead I in all 17 patients. A precordial R wave transition was also observed at V1 or V2 in 16 patients (94%). In 7 of 8 patients (88%) with Supra-Ao LVOT-VT, no S wave was observed in either V5 or V6. In contrast, an Rs pattern was observed in both V5 and V6, or in V6 only, in 100% of the patients with Infra-Ao LVOT-VT. A LVOT-VT should be suspected when the ECG shows an S wave in lead I and an R/S ratio greater than 1 in lead V1 or V2, versus a coronary cusp location if there is no S wave in either lead V5 or V6.
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Affiliation(s)
- H Hachiya
- Cardiology Department, Yokosuka Kyosai General Hospital 1-16, Yonegahamadori Yokosukashi, Kanagawa 238, Japan.
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Asso A, Pascual ED, López M, Rodriguez R, Casado J, Placer L. Catheter ablation of repetitive monomorphic ventricular tachycardia from left ventricular outflow tract guided by unipolar mapping. J Interv Card Electrophysiol 2000; 4:435-9. [PMID: 10936010 DOI: 10.1023/a:1009818904490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive monomorphic ventricular tachycardia from the left ventricular outflow tract is an uncommon arrhythmia. Successful catheter ablation has been previously reported in a few cases, but a large number of applications were usually needed when an approach based on either activation mapping or pace mapping was used. In our patient, the selection of the target point for application was based exclusively on unipolar mapping criteria of the ectopic beats, resulting in a short procedure with successful outcome.
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Affiliation(s)
- A Asso
- Electrophysiology Unit, Service of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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Abstract
Idiopathic ventricular tachycardia (VT) is characterized by two predominant forms. The most common form originates from the right ventricular outflow tract and presents as repetitive monomorphic VT or exercise-induced VT. The tachycardia is adenosine sensitive and is thought to be because of cAMP-mediated triggered activity. The other major form of idiopathic VT is owing to verapamil-sensitive intrafascicular re-entrant tachycardia, which most often originates in the region of the left posterior fascicle. Both forms of idiopathic VT can be readily treated with radiofrequency catheter ablation.
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Affiliation(s)
- B B Lerman
- Department of Medicine, New York Hospital-Cornell University Medical Center, New York, USA.
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