Idiopathic focal epicardial ventricular tachycardia originating from the crux of the heart

Doppalapudi, Harish; Yamada, Takumi; Ramaswamy, Karthik; Ahn, Joon Ho; Kay, G. Neal

doi:10.1016/j.hrthm.2008.09.029

Cited by 89 publications

(84 citation statements)

References 21 publications

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“…13 The crux of the heart is formed by the junction of the atrioventricular groove and posterior interventricular groove and corresponds roughly to the junction of the middle cardiac vein and CS, near the origin of the posterior descending coronary artery ( Figure 5). 12 When transvenous epicardial ablation is unsuccessful, transthoracic epi- …”

Section: Specific Concerns Of Each Arrhythmogenic Substratementioning

confidence: 99%

Transthoracic Epicardial Catheter Ablation

Yamada

2013

Circ J

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Section: Specific Concerns Of Each Arrhythmogenic Substratementioning

confidence: 99%

Transthoracic Epicardial Catheter Ablation

Yamada

2013

Circ J

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“…[1][2][3] The most common site of origins of idiopathic epicardial VAs is the LV summit that anatomically lies superior to the aortic portion of the LV ostium and occupies the most superior portion of the LV. 3 VAs originating from this region can be eliminated by radiofrequency catheter ablation (RFCA) applied within the great cardiac vein (GCV) or by using a transpericardial approach.…”

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confidence: 99%

Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery

Yamada

Doppalapudi

Litovsky

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs. Methods and Results-Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied. RFCA was successful within the main trunk of the GCV in 16 patients and within a branch of the GCV traversing the basal LV (B-LV) summit in 7. Transpericardial RFCA was successful on the epicardial surface in the A-LV summit in 6 patients and was abandoned in 14 with the B-LV summit VAs because of the close proximity to the coronary arteries and thick fat pads. RFCA was successful at the aortomitral continuity in 3 patients (2 with a failed transpericardial RFCA), and left coronary cusp in 1. The RFCA success rate of the A-LV summit VAs including the GCV VAs was 100% (22/22), whereas that of the B-LV summit VAs was 48% (11/23). The B-LV summit VAs could be differentiated from the A-LV summit VAs by left bundle branch block pattern, QRS duration ≤175 ms, precordial transition ≥V1, and maximum deflection index of ≥0.55. Conclusions-This study revealed that ≈50% of the B-LV summit VAs could be eliminated by a direct approach through a GCV branch running below the proximal left coronary arteries and a remote approach from the adjacent endocardial sites. (Circ Arrhythm Electrophysiol. 2016;9:e004202.

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“…8,21 Crux During crux IVAs, an early ventricular activation is recorded within the middle cardiac vein or proximal CS. 8,26 If the local ventricular activation and pace map at that site is suitable for ablation, irrigated …”

Section: Moderator Bandmentioning

confidence: 99%

“…25 There are two major sites of epicardial IVA origins such as the crux of the heart 26 and LV summit. 27 Anatomically, the crux of the heart is formed by the junction of the AV groove and posterior interventricular groove, and corresponds roughly to the junction of the middle cardiac vein and coronary sinus (CS), near the origin of the posterior descending coronary artery (see Figure 3A).…”

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“…27 Anatomically, the crux of the heart is formed by the junction of the AV groove and posterior interventricular groove, and corresponds roughly to the junction of the middle cardiac vein and coronary sinus (CS), near the origin of the posterior descending coronary artery (see Figure 3A). 26 A region of the LV epicardial surface that occupies the most superior portion of the LV has been termed the LV summit by McAlpine (see Figure 3B). 9,27 The LV summit is a triangular region bounded by the left anterior descending coronary artery anteriorly and left circumflex coronary artery posteriorly, and an imaginary arch sweeping from the first septal coronary artery across the lateral LV epicardium to the left AV groove.…”

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Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias

Yamada

Kay

2016

Arrhythmia &Amp; Electrophysiology Review

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Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs.

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Idiopathic focal epicardial ventricular tachycardia originating from the crux of the heart

Cited by 89 publications

References 21 publications

Transthoracic Epicardial Catheter Ablation

Transthoracic Epicardial Catheter Ablation

Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery

Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias

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