Elimination of Ventricular Arrhythmias Originating From the Anterior Interventricular Vein With Ablation in the Right Ventricular Outflow Tract

Frankel, David S.; Mountantonakis, Stavros; Dahu, Musa; Marchlinski, Francis E.

doi:10.1161/circep.114.001456

Cited by 30 publications

(22 citation statements)

References 4 publications

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“…1,9,13,14 In many of these cases, radiofrequency delivery from adjacent sites, such as the endocardial LV/RV, coronary cusp region or coronary venous system is successful in eliminating the arrhythmias. [3][4][5] In this regard, intracardiac echocardiography together with 3-dimensional electroanatomic mapping is particularly valuable in defining the anatomic details of structures adjacent to the epicardial LVS; however, in this series, intracardiac echocardiography did not enhance ablation success. In a recent study by our group, successful ablation of VAs from the inaccessible LVS area was achieved from the left coronary cusp in 56% of cases.…”

Section: Epicardial Catheter Ablation Of Vas From the Lvsmentioning

confidence: 82%

“…2 Given the proximity to major coronary vessels and the presence of a thick layer of epicardial fat in this location, 1,2 catheter ablation of VAs originating from the LVS with a percutaneous epicardial approach is challenging; in many cases, ablation from adjacent structures such as the left coronary cusp, the GCV-AIV junction, the endocardial aspect of basal LV (immediately below the aortic valve), and the septal right ventricular (RV) outflow tract at its leftmost aspect is an effective alternative approach to achieve success. [3][4][5] However, when ablation of LVS VA from these alternative locations is unsuccessful, an epicardial approach might be considered. 1,6 In this study, we report the outcomes of percutaneous epicardial mapping and ablation of VAs originating from the LVS, and the electrocardiographic features predicting successful ablation.…”

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confidence: 99%

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Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit

Santangeli

Marchlinski

Zado

et al. 2015

Circ: Arrhythmia and Electrophysiology

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142

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Background-Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results-Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-wave amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group (P=0.008). The ratio of R/S wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group (P=0.056). None of the patients in the successful group had an initial q wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions-Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of q waves in lead V1 help identify appropriate candidates for epicardial ablation.

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Section: Epicardial Catheter Ablation Of Vas From the Lvsmentioning

confidence: 82%

mentioning

confidence: 99%

Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit

Santangeli

Marchlinski

Zado

et al. 2015

Circ: Arrhythmia and Electrophysiology

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142

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“…Other treatment options include ablating from the left sinus of Valsalva, the best contiguous endocardial site (including the aortomitral continuity), or the most leftward aspect of the posterior RVOT septum, which is often <1 cm from the anterior interventricular vein. [57][58][59] Ablation at these sites might be successful despite slightly later activation (<10 ms) and poor pace-map correlations. If these measures fail, percutaneous epicardial ablation in the region of the left ventricular summit can be considered.…”

Section: Treatmentmentioning

confidence: 99%

Mechanism, diagnosis, and treatment of outflow tract tachycardia

Lerman

2015

Nat Rev Cardiol

103

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Idiopathic ventricular arrhythmia is a generic term for a spectrum of arrhythmias that occur in the absence of structural heart disease or ion channelopathy. These arrhythmias include monomorphic premature ventricular contractions (PVCs), nonsustained monomorphic ventricular tachycardia (VT), and sustained VT. Most idiopathic ventricular arrhythmias originate from the right and left ventricular outflow tracts and include sites accessed from the aortic sinuses of Valsalva. Outflow tract arrhythmia is identified by an electrocardiographic pattern consistent with a left bundle branch block inferior axis morphology. Characteristically, outflow tract VT is caused by cAMP-mediated triggered activity, and is terminated by administration of adenosine. Outflow tract arrhythmias are focal and, therefore, are readily amenable to definitive treatment with catheter-based radiofrequency ablation. Although arrhythmia might be associated with reversible PVC-mediated cardiomyopathy, and infrequently with PVC-induced polymorphic VT or ventricular fibrillation, prognosis is generally favourable.

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“…Since the anterior aspect of the RVOT lies near the AIV, PVCs from the AIV can occasionally be ablated from the RVOT . In our study, 83.3% of LBRI VAs with a QS pattern in lead I could be successfully eliminated from the anterior aspect of the RVOT just below/above the pulmonic valve.…”

Section: Discussionmentioning

confidence: 99%

Lead I R‐wave amplitude to differentiate idiopathic ventricular arrhythmias with left bundle branch block right inferior axis originating from the left versus right ventricular outflow tract

Xie

Kubala

Liang

et al. 2018

Cardiovasc electrophysiol

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Elimination of Ventricular Arrhythmias Originating From the Anterior Interventricular Vein With Ablation in the Right Ventricular Outflow Tract

Cited by 30 publications

References 4 publications

Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit

Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit

Mechanism, diagnosis, and treatment of outflow tract tachycardia

Lead I R‐wave amplitude to differentiate idiopathic ventricular arrhythmias with left bundle branch block right inferior axis originating from the left versus right ventricular outflow tract

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