Catheter Ablation of Premature Ventricular Contractions Originating in the Aortic Sinus Cusp or Great Cardiac Vein: Two QRS Morphologies with One Origin

Wang, Yubin; Ma, Juan; Dong, Jianzeng; Bai, Rong; Wang, Jing; Li, Songnan; Yu, Rong‐Hui; Ma, Changsheng; Chu, Jianmin

doi:10.1111/pace.12652

Cited by 10 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some authors have reported that VTs originating from one focus in the LVS can present with multiple morphologies due to different exit sites . PVCs from this area are often targeted from the CS system (AIV/GCV) but can also be accessed directly via pericardial puncture.…”

Section: Discussionmentioning

confidence: 99%

High‐density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract

Simone

Rocca

Panella

et al. 2018

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageThe Rhythmia ultrahigh‐density mapping system with a specific algorithm seems to be helpful in identifying the target area to successfully treat multiple morphologies by catheter ablation in the right ventricular outflow tract RVOT. Interestingly, the acquisition process seemed to be extremely faster than a standard manual point‐by‐point premature ventricular contraction (PVC) mapping.

show abstract

Section: Discussionmentioning

confidence: 99%

High‐density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract

Simone

Rocca

Panella

et al. 2018

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…Radiofrequency catheter ablation (RFCA) has been found to be more effective in the treatment of RVOT VAs, as it is associated with minor complications as compared to drug therapies, especially in the condition that antiarrhythmic drugs are ineffective, intolerable, or undesired . With the development of three‐dimensional mapping systems and angiography techniques, it has been observed that LBBB‐like VTs or VPCs can also originate from other ectopic foci, including septum, aortic sinus cusp, epicardium, His bundle, and tricuspid annulus . It is conceivable that failing to find the very origination site is the main reason for unsuccessful ablation for RVOT‐like VAs, and a better understanding and previously locating the origin site of LBBB‐like VAs are essential to greatly increase the success rate of catheter ablation .…”

Section: Introductionmentioning

confidence: 99%

Pulmonary artery: A pivotal site for catheter ablation in idiopathic RVOT ventricular arrhythmias

Wang

Zhang

Hong

et al. 2017

Pacing Clinical Electrophis

View full text Add to dashboard Cite

In patients without associated myocardial diseases, characterized by left bundle branch block and inferior axis morphologies, repetitive idiopathic right ventricular tachycardias and ventricular premature contractions typically arise from right ventricular outflow tract (RVOT). Accumulated evidences have shown that radiofrequency catheter ablation is a useful treatment for patients with RVOT ventricular arrhythmias (VAs). Interestingly, several medical centers have shown that pulmonary artery (PA) is a potential novel site for catheter ablation in RVOT-like VAs, particularly in patients where termination of RVOT VAs at the usual site fails. In this review, we comprehensively demonstrated that RVOT VAs were successfully terminated at the site of PA, analyzed the characteristics of surface electrocardiogram and endocardial potentials, and explored the underlying mechanisms for these cases.

show abstract

“…1 They present the characteristics of 10 patients with premature ventricular complexes (PVCs) of two morphologies, one left bundle branch block (LBBB), the other right bundle branch block (RBBB), which were ablated from a single region. These patients were identified from a series of 247 patients with idiopathic outflow tract PVCs.…”

mentioning

confidence: 99%

The “Duality” of Idiopathic Ventricular Arrhythmias from the Left Ventricular Ostium

Callans

2015

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Just like the roman god Janus people have two sides. A good side, a bad side, a past, a future. And we must embrace both in someone we love.-UnknownIn this issue of Pacing and Clinical Electrophysiology, Wang et al. present an interesting retrospective analysis of a unique group of patients that yields insight about the complexity of ventricular arrhythmias that arise from the left ventricular (LV) ostium.1 They present the characteristics of 10 patients with premature ventricular complexes (PVCs) of two morphologies, one left bundle branch block (LBBB), the other right bundle branch block (RBBB), which were ablated from a single region. These patients were identified from a series of 247 patients with idiopathic outflow tract PVCs. The methods included electroanatomic mapping, irrigated radiofrequency ablation, and site verification within the aortic sinus cusps (ASC) with transthoracic echocardiography or contrast aortography. Review of the individual electrocardiograms supports the authors' claims that all of the LBBB PVCs would have been expected to exit from the right ventricular outflow tract (LBBB, no broad r wave in the early precordial leads, late transition), and all RBBB PVCs from the sinuses of Valsalva (ASC) or the great cardiac vein (GCV).2,3 Patients were divided into two groups: group 1 patients (seven) had more frequent LBBB PVCs and group 2 (three) more frequent RBBB PVCs. Accordingly, in group 1 patients, mapping commenced in the superior septal right ventricular outflow tract (RVOT) where earliest activation was −27 ± 6 ms (range −18 to −36) from the QRS onset. Pace mapping at the earliest right ventricle (RV) site provided a "similar" match but ablation in the RVOT had no effect. The earliest site of activation in the ASC was −27 ± 5 ms (range −18 to −34), later than the RV in six of seven patients. Pace mapping at this site was performed in five patients, and in three both PVCs morphologies could be reproduced with pacing at the earliest site, with different stimulus-QRS intervals (longer for the LBBB PVC). The distance between sites of earliest RV and LV activation was 13 ± 5.4 mm. Ablation in the ASC (left coronary cusp in five, junction of the right and left commissure in two) was successful in all group 1 patients. In group 2 patients, only left-sided mapping was performed. At sites of earliest activation (left coronary cusp in two, GCV in one), pace maps for the RBBB PVC were matching and ablation was successful. There were no procedural complications and no recurrent arrhythmias over a mean follow-up of 18.4 ± 5.1 months. The authors conclude that dual morphologies could be a predictor of PVCs arising from the ASC or GCV.This work is largely presaged by a series of observations from Yamada et al., which provide a practical electrophysiologic analysis of the pioneering anatomic treatise by McAlpine. 4 In their "Advances" manuscript, 5 which we would highly recommend to interested readers, after providing an excellent review of the intricate anatomy of this region, they conclude, "Althou...

show abstract

Catheter Ablation of Premature Ventricular Contractions Originating in the Aortic Sinus Cusp or Great Cardiac Vein: Two QRS Morphologies with One Origin

Abstract: Two QRS morphologies (LBBB and RBBB with inferior axis) in PVCs could be a predictor of PVCs originating from ASC or GCV.

Cited by 10 publications

References 18 publications

High‐density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract

High‐density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract

Pulmonary artery: A pivotal site for catheter ablation in idiopathic RVOT ventricular arrhythmias

The “Duality” of Idiopathic Ventricular Arrhythmias from the Left Ventricular Ostium

Contact Info

Product

Resources

About