Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle

Ceresnak, Scott R.; Pass, Robert H.; Krumerman, Andrew; Kim, Soo G.; Nappo, Lynn; Fisher, John D.

doi:10.1016/j.jelectrocard.2012.03.009

Cited by 12 publications

(6 citation statements)

References 12 publications

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“…6 Similarly, previous studies of moderator band and para-Hisian PVCs have rarely shown ILD. 2,3,7 While the authors did not find other locations in their current series, they do mention the potential overestimation of the specificity and sensitivity of ILD. This cohort included 11 mitral annuli and five tricuspid annuli PVCs that did not have ILD.…”

contrasting

confidence: 52%

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Localization of ventricular arrhythmias: The importance of evaluating the frontal axis

2017

Cardiovasc electrophysiol

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contrasting

confidence: 52%

“…Interestingly, prior reports of anterolateral papillary muscle ventricular arrhythmias have not shown ILD . Similarly, previous studies of moderator band and para‐Hisian PVCs have rarely shown ILD …”

mentioning

confidence: 83%

Localization of ventricular arrhythmias: The importance of evaluating the frontal axis

2017

Cardiovasc electrophysiol

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“…Recently, it has been reported that the para‐Hisian region is an important site of VAs originating from the RV . However, catheter ablation of para‐Hisian VAs represents a challenging task and the success rate is lower than that of RVOT VAs . Sometimes, it needs to mapping and ablation in the aortic cusp, such as a right coronary cusp (RCC) or noncoronary cusp (NCC), which is adjacent to the membranous septum .…”

Section: Introductionmentioning

confidence: 99%

“…than that of RVOT VAs. 9 Sometimes, it needs to mapping and ablation in the aortic cusp, such as a right coronary cusp (RCC) or noncoronary cusp (NCC), which is adjacent to the membranous septum. 8 Tada et al 5 reported that 57% of success rate was achieved for catheter ablation of the VAs arising from the septum of the tricuspid annulus.…”

mentioning

confidence: 99%

Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Sun

Zhang

Wang

et al. 2019

Cardiovasc electrophysiol

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Aims Ventricular arrhythmias (VAs) originating from the para‐Hisian region represent a challenging location. The long‐term success rate of catheter ablation above the septal leaflet of the tricuspid valve is not ideal. This study aimed to investigate the safety and efficacy of catheter ablation for para‐Hisian VAs via a direct approach under the septal valve with reversed C‐curve technique. Methods and Results Twenty‐five consecutive patients with para‐Hisian VAs were included. Systematic mapping was performed in the right ventricle septum, including both the regions above and under the septal valve. Radiofrequency (RF) ablation was preferentially performed under the valve with reversed C‐curve technique in all patients. If the ablation failed under the valve, it was then performed above the valve and even in aortic sinus cusps. The earliest ventricular activation preceding surface QRS (V‐QRS) under the valve was significantly larger than that above the valve (34.8 ± 5.3 vs 27.8 ± 5.7 ms, P < .01). RF ablation under the valve with reversed C‐curve technique achieved acute success in 22 of 25 (88%) patients. Junctional rhythm developed during ablation in 3 of 25 (12%) patients and no atrioventricular block occurred. In the remaining three patients, RF application above the valve failed to eliminate the VAs and one of them achieved successful ablation in the right coronary cusp. During a mean follow‐up of 17.8 ± 9.4 months, no patients presented with VAs recurrence and no postprocedure complications occurred. Conclusions Catheter ablation under the valve with reversed C‐curve technique shows to be effective and safe for para‐Hisian VAs.

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“…Most idiopathic ventricular arrhythmias (VAs) including ventricular tachycardia (VT) and premature ventricular contractions (PVCs), originate from the right ventricular (RV) outflow tract (RVOT) [1,2]. A few studies have demonstrated idiopathic VAs arising from the para-Hisian region [3][4][5][6][7][8][9]. In terms of their electrocardiographic and electrophysiological features, VAs originating from the para-Hisian area are similar to those originating from the RVOT, the coronary cusp adjacent to the membranous septum, or the left ventricular (LV) septum below the aortic valve [4,5,10].…”

Section: Introductionmentioning

confidence: 99%

Idiopathic ventricular arrhythmia originating from the para‐Hisian area: Prevalence, electrocardiographic and electrophysiological characteristics

Ban

Chen

Park

et al. 2013

Journal of Arrhythmia

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Background We investigated the prevalence and the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs) originating from the para‐Hisian area. Methods Among 250 patients with idiopathic VAs, 8 (3.2%) had an ablation site in the para‐Hisian region. For comparison with right ventricular (RV) para‐Hisian VAs (n=6), 27 patients with VAs originating from the posterior RV outflow tract (RVOT) were studied. Results Para‐Hisian VAs had an R wave in leads I and aVL. The VAs originating from the site below the His bundle region were determined to have a superior axis (n=4, 50%). A His potential was recorded at the proximal bipole of the successful ablation site in 6 patients. RV para‐Hisian VAs had a narrower QRS width (114±12 ms vs. 139±12 ms, P=0.003), as well as a higher incidence of R waves in lead aVL (83.3% vs. 0%, P<0.001) and QS waves in lead V1 (83.3% vs. 22.2%, P=0.004) compared to posterior RVOT VAs. A greater R wave amplitude in lead I (1.15±0.34 mV vs. 0.34±0.18 mV, P=0.001) and a smaller R wave amplitude in the inferior leads (0.68±0.23 mV vs. 1.58±0.55 mV, P<0.001), with a higher R wave amplitude ratio in leads II/III (4.2±2.0 vs. 1.1±0.2, P=0.01) were the major ECG characteristics. Conclusions Para‐Hisian VAs have distinctive electrocardiographic features and can be successfully eliminated without disturbance of atrioventricular conduction.

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Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle

Cited by 12 publications

References 12 publications

Localization of ventricular arrhythmias: The importance of evaluating the frontal axis

Localization of ventricular arrhythmias: The importance of evaluating the frontal axis

Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Idiopathic ventricular arrhythmia originating from the para‐Hisian area: Prevalence, electrocardiographic and electrophysiological characteristics

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