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Lin YF, Xu Q, Zheng C, Shao JM, Shen B, He RL, Lin JF, Chen YR. Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus. J Cardiovasc Dev Dis 2023; 10:334. [PMID: 37623347 PMCID: PMC10455119 DOI: 10.3390/jcdd10080334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). METHODS This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively. RESULTS The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively. CONCLUSION the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia's origin and designing the ablation plan accordingly.
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Affiliation(s)
- Yi-Fan Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
- Department of Cardiology, The Third Affiliated Hospital of Wenzhou Medical University and Ruian People’s Hospital, Wenzhou 325000, China
| | - Que Xu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Cheng Zheng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Jia-Meng Shao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Bing Shen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Rui-Lin He
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Jia-Feng Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
| | - Yan-Ru Chen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, China; (Y.-F.L.); (Q.X.); (C.Z.); (J.-M.S.); (B.S.); (R.-L.H.)
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Liang Z, Zhang T, Liu L, Qi S, Liu X, Li Q, Fang D, Wang Y, Ma C. Catheter ablation of ventricular premature depolarizations originating from mid interventricular septum: Significance of electrocardiographic morphology for predicting origin. Heart Rhythm 2023:S1547-5271(23)02253-1. [PMID: 37225113 DOI: 10.1016/j.hrthm.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ventricular premature depolarizations (VPDs) originating from the mid interventricular septum (IVS) adjacent to the atrioventricular annulus between the His bundle and coronary sinus ostium (mid IVS VPDs) have not been characterized. OBJECTIVE The aim of this study was to investigate the electrophysiological characteristics of mid IVS VPDs. METHODS Thirty-eight patients with mid IVS VPDs were enrolled. The VPDs were divided into different types according to precordial transition of the electrocardiogram (ECG) and the QRS morphology in lead V1. RESULTS 4 types of VPDs were divided. The precordial transition zone appeared earlier and earlier from types 1 to 4. The notch in V1 moved gradually backwards, its amplitude gradually became higher, resulting in transition from left to right bundle branch block morphology in V1 from types 1 to 4. Based on activation and pace mapping, ablation response, and the 3830 electrode pacing morphology in the mid IVS, the 4 types of ECG morphology corresponded, respectively, to an origin in the right endocardial side, right/mid intramural region, left intramural region, and left endocardial side of the mid IVS. An intramural origin was identified for 50% of the VPDs. 89% of mid IVS VPDs could be eliminated. Bilateral ablation (waiting for delayed efficacy) or bipolar ablation was sometimes needed for intramural VPDs. CONCLUSIONS Mid IVS VPDs were found to have unique electrophysiological characteristics. The ECG characteristics of mid IVS VPDs was important in terms of prediction of its exact origin, the choice of ablation method, and the likelihood of treatment being successful.
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Affiliation(s)
- Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Tao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Lifeng Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing, China
| | - Shuying Qi
- Department of Cardiology, 980(th) Hospital of the Joint Logistic Support Force of PLA, Shijiazhuang, Hebei, China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Qiaoyuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Dongping Fang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Yunlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China.
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Beijing, China.
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Qu L, Guo M, Zhang N, Sun M, Wang R. The characteristics of a 12-lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method. Ann Noninvasive Electrocardiol 2023; 28:e13024. [PMID: 36573893 PMCID: PMC10023889 DOI: 10.1111/anec.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the conventional surface electrocardiogram (ECG) characteristics of premature ventricular contractions (PVCs) originating from the tricuspid annulus and to investigate the efficacy of locating their origins according to ECG results. METHODS Eight patients who underwent radiofrequency ablation in the First Hospital of Shanxi Medical University (China) were included in the study. Pace mapping (PM) was used to analyze the characteristics of the PVCs originating from the tricuspid annulus recorded via 12-lead body surface ECGs. RESULTS An R-wave was found in leads I, V5 , and V6 . The QRS wave was narrower when the PVCs originated from the septum and shifted in lead V3 (R-wave amplitude/S-wave amplitude in the precordial lead-1). The QRS wave was broadest when the PVCs originated from the 7 to 9 o'clock position. The augmented vector left lead showed RS, QS, or RSR-type waves with a low amplitude when the PVCs originated from the upper part of the annulus. When the PVCs originated from the lower part of the annulus, the augmented vector right lead reflected multidirectional and QS-type waves. CONCLUSION The ECG-lead characteristics related to the origin of PVCs in the tricuspid annulus indicate some level of significance and can be used to formulate a specific diagnosis.
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Affiliation(s)
- Li‐juan Qu
- Department of CardiologyFirst hospital of Shanxi Medical UniversityTaiyuanChina
| | - Min Guo
- Department of CardiologyFirst hospital of Shanxi Medical UniversityTaiyuanChina
| | - Nan Zhang
- Department of CardiologyFirst hospital of Shanxi Medical UniversityTaiyuanChina
| | - Meng Sun
- Department of CardiologyFirst hospital of Shanxi Medical UniversityTaiyuanChina
| | - Rui Wang
- Department of CardiologyFirst hospital of Shanxi Medical UniversityTaiyuanChina
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Hu Z, Jiang Y, Wang S. Premature ventricular contractions with acute successful radiofrequency catheter ablation near the atrioventricular node using reversed C curve technique. BMC Cardiovasc Disord 2022; 22:390. [PMID: 36045329 PMCID: PMC9429768 DOI: 10.1186/s12872-022-02832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background We sought to clarify the electrophysiological (EP) characteristics of premature ventricular contractions (PVCs) with acute successful radiofrequency catheter ablation (RFCA) near the atrioventricular node (AVN). Methods and results Eighteen patients with acute successful RFCA near the AVN were included in this study. Systematic mapping was performed with two mapping methods: antegrade mapping technique (group A) and reversed C curve mapping technique (group R). RFCA was preferentially performed underneath the tricuspid valve (TV) with reversed C curve technique in all patients. The a amplitude/v amplitude ratio during sinus rhythm in group A was significantly larger than in group B (0.19 ± 0.10 vs 0.06 ± 0.02, p < 0.01). The earliest bipolar activation preceded the QRS onset in group A was significantly smaller than in group R (19.6 ± 4.9 vs 24.4 ± 6.6 ms (ms), p < 0.01). Pace mapping in group A and group R demonstrated perfect QRS morphology (12/12) match only in 5.6% (one patient) and 16.7% (3 patients) of patients, respectively. The mean duration of successful RFCA was 8.2 ± 2.4 s in 13 patients (72.2%). Early (within 3 days) and late (one-year) recurrence rates were 5.6% (one patient) and 16.7% (3 patients), respectively. No atrioventricular block occurred during RFCA or the one-year follow up. Conclusions PVCs near the AVN are a subgroup of idiopathic PVCs with distinctive EP features. RFCA using reversed C curve technique is effective and safe for the acute elimination of these challenging AVN-PVCs.
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Kong LC, Shuang T, Li Z, Zou ZG, Jiang WL, Pu J, Wang XH. A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation. Front Cardiovasc Med 2022; 9:844320. [PMID: 35310983 PMCID: PMC8924133 DOI: 10.3389/fcvm.2022.844320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.
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Yue-Chun L, Yuan-Nan L, Jing X, Yang-Qi P, Cheng Z, Yang-Jing X, Jia-Xuan L, Jin L, Jia L, Jia-Feng L. R/S Ratio in Lead III Predicts Successful Ablation of Ventricular Arrhythmias Originating in Para-Hisian Region. JACC Clin Electrophysiol 2021; 7:719-730. [PMID: 33516713 DOI: 10.1016/j.jacep.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating near the His bundle (HB) and use the R/S ratio in lead III (RIII/SIII ratio) to predict successful ablation of para-Hisian VAs. BACKGROUND Catheter ablation for idiopathic VAs near the HB is often challenging, and data are limited. METHODS The present study included 134 consecutive patients undergoing catheter ablation of para-Hisian VAs. The electrocardiographic characteristics in these patients were retrospectively evaluated with successful ablation and failed ablation. RESULTS Successful ablation was achieved in 115 (85.8%) of the 134 patients. There was no significant difference in QRS duration between the successful and the failed ablation groups. The ablation success rate was significantly lower for para-Hisian VAs with a predominantly positive R wave in lead III than those with a predominantly negative S wave in lead III. The significant factor associated with successful ablation was the RIII/SIII ratio. The RIII/SIII ratio ≤1.1 predicted the successful ablation of para-Hisian VAs with high sensitivity (80.9%) and specificity (94.7%). The RIII/SIII ratio of >1.2 had high sensitivity (100.0%) and specificity (82.8%) to predict the distance <5 mm from the site of origin of para-Hisian VAs to the site recording the largest HB potential. CONCLUSIONS The RIII/SIII ratio was a helpful predictor of the successful ablation of VAs originating in the vicinity of the HB. This may be useful for planning ablation of para-Hisian VAs and minimizing the risk of inadvertent atrioventricular block.
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Affiliation(s)
- Li Yue-Chun
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Yuan-Nan
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xu Jing
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pan Yang-Qi
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zheng Cheng
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xue Yang-Jing
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Jia-Xuan
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Jin
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Jia
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Jia-Feng
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
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Li J, Lin W, Zheng C, Zhang C, Yu J, Lin J. Implication of the distinctive bipolar intracardiac electrograms for ventricular arrhythmias arising from different regions of ventricular outflow tract. Europace 2020; 22:1367-1375. [PMID: 32449935 DOI: 10.1093/europace/euaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To investigate the characteristics of bipolar intracardiac electrograms (bi-EGMs) in target sites of ventricular arrhythmias (VAs) originating from different regions of ventricular outflow tract (VOT). METHODS AND RESULTS Two hundred and seventy patients undergoing first-time ablation for VAs originated from distal great cardiac vein (DGCV), aortic sinus cusps (ASCs), or pulmonary sinus cusps (PSCs) were enrolled in present study. Local intracardiac bipolar recordings on 243 successful sites and 506 attempted but unsuccessful ablation sites were analysed. Specific potentials in bi-EGMs on successful sites were more common compared with unsuccessful sites (76.95%, 187/243 vs. 25.49%, 129/506, P < 0.05). A total of 60.00% (81/135) patients in ASCs group presented a presystolic short-duration fractionated potential, higher than 23.21% (13/56) in DGCV and 23.08% (12/52) in PSCs (all P < 0.05); 44.23% (23/52) patients in PSC group showed a presystolic high-amplitude discrete potential, while 1.79% (1/56) in DGCV and 2.22% (3/135) in ASCs (all P < 0.05); 41.07% (23/56) patients in DGCV group showed bi-EGMs of presystolic long-duration multicomponent fractionated potential, which was significantly higher than 3.85% (2/52) in PSCs and 4.44%(6/135) in ASCs (all P < 0.05). CONCLUSION Distinctive morphology of bi-EGMs during VAs can be found in different regions of VOT, which probably due to changes in the arrangements of myocardial sleeves. Correct identification and better understanding of the distinctive features of these bi-EGMs with regards to the anatomic location was important, the presence of specific potentials may add help in successful ablation.
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Affiliation(s)
- Jia Li
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Weiqian Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Cheng Zheng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Chi Zhang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Jiji Yu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Jiafeng Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
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