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Lai Y, Gao M, Li Q, Li M, Zhang J, Li X, Guo Q, Huang L, Jiang C, Li S, Guo X, Zuo S, Liu N, Wang W, Zhao X, Sang C, Tang R, Long D, Dong J, Ma C. Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins. Circ Arrhythm Electrophysiol 2024; 17:e012513. [PMID: 38690657 DOI: 10.1161/circep.123.012513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported. METHODS Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation. RESULTS Patients enrolled had a median age of 30 (11-51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V1, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60-20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence was observed during 36 (10-60) months follow-up. CONCLUSIONS The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.
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Affiliation(s)
- Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Mingyang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Qifan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Jianghua Zhang
- First Affiliated Hospital of Xinjiang Medical University, China (J.Z., J.D.)
| | - Xuexun Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, China (X.L.)
| | - Qi Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Lihong Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
| | - Jianzeng Dong
- First Affiliated Hospital of Xinjiang Medical University, China (J.Z., J.D.)
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Y.L., M.G., Q.L., M.L., Q.G., L.H., C.J., S.L., X.G., S.Z., N.L., W.W., X.Z., C.S., R.T., D.L., C.M.)
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