TY - JOUR
T1 - Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region
T2 - ECG features, anatomic distance, and outcome
AU - Jauregui Abularach, Miguel E.
AU - Campos, Bieito
AU - Park, Kyoung Min
AU - Tschabrunn, Cory M.
AU - Frankel, David S.
AU - Park, Robert E.
AU - Gerstenfeld, Edward P.
AU - Mountantonakis, Stavros
AU - Garcia, Fermin C.
AU - Dixit, Sanjay
AU - Tzou, Wendy S.
AU - Hutchinson, Mathew D.
AU - Lin, David
AU - Riley, Michael P.
AU - Cooper, Joshua M.
AU - Bala, Rupa
AU - Callans, David J.
AU - Marchlinski, Francis E.
N1 - Funding Information:
This work was supported in part by the Harlan Batrus and Murray Bloom Research Funds at the University of Pennsylvania. Dr Jauregui Abularach was awarded a research grant by Fundació d'Investigació Cardiovascular and Unitat d'Arítmies Hospital de la Santa Creu i Sant Pau , Barcelona, Spain.
PY - 2012/6
Y1 - 2012/6
N2 - Background: Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system. Objective: To describe the characteristics of an alternative successful ablation strategy targeting the left sinus of Valsalva (LSV) and/or the adjacent left ventricular (LV) endocardium. Methods: Of 276 patients undergoing mapping/ablation for outflow tract VT/VPDs, 16 consecutive patients (8 men; mean age 52 ± 17 years) had an ablation attempt from the LSV and/or the adjacent LV endocardium for VT/VPDs mapped marginally closer to the distal great cardiac vein (GCV) or anterior interventricular vein (AIV). Results: Successful ablation was achieved in 9 of the 16 patients (56%) targeting the LSV (5 patients), adjacent LV endocardium (2 patients), or both (2 patients). The R-wave amplitude ratio in lead III/II and the Q-wave amplitude ratio in aVL/aVR were smaller in the successful group (1.05 ± 0.13 vs 1.34 ± 0.37 and 1.24 ± 0.42 vs 2.15 ± 1.05, respectively; P =.043 for both). The anatomical distance from the earliest GCV/AIV site to the closest point in the LSV region was shorter for the successful group (11.0 ± 6.5 mm vs 20.4 ± 12.1 mm; P =.048). A Q-wave ratio of <1.45 in aVL/aVR and an anatomical distance of <13.5 mm had sensitivity and specificity of 89%, 75% and 78%, 64%, respectively, for the identification of successful ablation. Conclusions: VT/VPDs originating near the GCV/AIV can be ablated from the LSV/adjacent LV endocardium. A Q-wave ratio of <1.45 in aVL/aVR and a close anatomical distance of <13.5 mm help identify appropriate candidates.
AB - Background: Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system. Objective: To describe the characteristics of an alternative successful ablation strategy targeting the left sinus of Valsalva (LSV) and/or the adjacent left ventricular (LV) endocardium. Methods: Of 276 patients undergoing mapping/ablation for outflow tract VT/VPDs, 16 consecutive patients (8 men; mean age 52 ± 17 years) had an ablation attempt from the LSV and/or the adjacent LV endocardium for VT/VPDs mapped marginally closer to the distal great cardiac vein (GCV) or anterior interventricular vein (AIV). Results: Successful ablation was achieved in 9 of the 16 patients (56%) targeting the LSV (5 patients), adjacent LV endocardium (2 patients), or both (2 patients). The R-wave amplitude ratio in lead III/II and the Q-wave amplitude ratio in aVL/aVR were smaller in the successful group (1.05 ± 0.13 vs 1.34 ± 0.37 and 1.24 ± 0.42 vs 2.15 ± 1.05, respectively; P =.043 for both). The anatomical distance from the earliest GCV/AIV site to the closest point in the LSV region was shorter for the successful group (11.0 ± 6.5 mm vs 20.4 ± 12.1 mm; P =.048). A Q-wave ratio of <1.45 in aVL/aVR and an anatomical distance of <13.5 mm had sensitivity and specificity of 89%, 75% and 78%, 64%, respectively, for the identification of successful ablation. Conclusions: VT/VPDs originating near the GCV/AIV can be ablated from the LSV/adjacent LV endocardium. A Q-wave ratio of <1.45 in aVL/aVR and a close anatomical distance of <13.5 mm help identify appropriate candidates.
KW - Coronary venous system
KW - Left sinus of Valsalva
KW - Left ventricular outflow tract
KW - Ventricular tachycardia ablation
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U2 - 10.1016/j.hrthm.2012.01.022
DO - 10.1016/j.hrthm.2012.01.022
M3 - Article
C2 - 22306618
AN - SCOPUS:84861329940
SN - 1547-5271
VL - 9
SP - 865
EP - 873
JO - Heart Rhythm
JF - Heart Rhythm
IS - 6
ER -