Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Abstract

AbstractsPanoptic studies of ventricular tachycardia (VT) originating above the pulmonary valve are scarce. The purpose of this study is to clarify the characteristic of idiopathic VT arising above pulmonary valve. We analyzed 15 consecutive patients with idiopathic VT that was successfully abolished by catheter ablation at the right ventricular outflow tract (RVOT-VT, n = 11) and above the pulmonary valve (PA-VT, n = 4). Incidence of syncope was higher in PA-VT than RVOT-VT (100 % vs 27 %, P < 0.05) and polymorphic VT was also more prevalent in PA-VT (75 % vs 0 %, P < 0.05). The coupling interval (315 ± 29 ms vs 449 ± 32 ms, mean ± SE) at the onset of VT and minimum cycle length (CL) (192 ± 13 ms vs 344 ± 37 ms) during VT were shorter in PA-VT (both P < 0.05). Among 12-lead ECG parameters, only R-wave amplitude in lead II was different between groups (2.05 ± 0.17 mV in PA-VT vs 1.44 ± 0.05 mV in RVOT-VT, P < 0.005). At the successful ablation site, the activation time from the onset of QRS complex did not differ between groups ( -37 ± 3 ms vs -31 ± 4 ms, P = 0.405), whereas the amplitude of intracardiac electrograms was significantly lower in PA-VT (0.83 ± 0.38 mV vs 2.39 ± 0.36 mV, P < 0.05). Although the number of patients in this study is limited, VT originating above the pulmonary valve demonstrated rapid excitation and often degenerated into polymorphic VT, suggesting its malignant electrophysiological characteristics.

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

“…Also, the incidence of syncope and polymorphic VT was high in all PA VT patients as compared to RVOT VT patients. 32 These findings showed that catheter ablation of RVOT-like VAs in PA is safe and efficacious, and PA is the potential novel site for catheter ablation in patients with RVOT-like VAs, which may contribute to the increased success rate of RFCA in the treatment of RVOT-like VAs.…”

Catheter ablation in a pediatric patient with idiopathic ventricular tachycardia and arrhythmia‐induced cardiomyopathy

“…However, with ventricular arrhythmias (VAs) originating from the RVOT, there have been reports of a few occurrences of cardiac events such as syncope or sudden cardiac death in pediatric patients 1,2 . Although cardiac complications are very rare in pediatric patients with VT arising from RVOT, the rapid excitation and conduction delays of ventricular arrhythmia originating above pulmonary valve appear to contribute polymorphic VT, suggesting its malignant electrophysiological characteristics 3,4 . We believed that this patient developed heart failure and arrhythmia‐induced cardiomyopathy because of the persistence of VT, which was at a relatively low heart rate with no accompanying palpitations, rather than frequent PVCs.…”