TY - JOUR
T1 - Idiopathic ventricular arrhythmias originating from the moderator band
T2 - Electrocardiographic characteristics and treatment by catheter ablation
AU - Sadek, Mouhannad M.
AU - Benhayon, Daniel
AU - Sureddi, Ravi
AU - Chik, William
AU - Santangeli, Pasquale
AU - Supple, Gregory E.
AU - Hutchinson, Mathew D.
AU - Bala, Rupa
AU - Carballeira, Lidia
AU - Zado, Erica S.
AU - Patel, Vickas V.
AU - Callans, David J.
AU - Marchlinski, Francis E.
AU - Garcia, Fermin C.
N1 - Funding Information:
This work was supported in part by the F. Harlan Batrus Research Fund. Drs. Marchlinski, Garcia, and Callans received research grant support and honoraria from Biosense Webster on topics unrelated to the content of this study.
Publisher Copyright:
© 2015 Heart Rhythm Society. All rights reserved.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.
AB - BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.
KW - Catheter ablation
KW - Idiopathic ventricular fibrillation
KW - Intracardiac echocardiography
KW - Moderator band
KW - Premature ventricular contractions
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U2 - 10.1016/j.hrthm.2014.08.029
DO - 10.1016/j.hrthm.2014.08.029
M3 - Article
C2 - 25240695
AN - SCOPUS:84920686839
SN - 1547-5271
VL - 12
SP - 67
EP - 75
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -