Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

Huang, Hung-Kai; Lin, Yenn‐Jiang; Lo, Li‐Wei; Hu, Yu‐Feng; Tuan, Ta‐Chuan; Chao, Tze‐Fan; Liao, Jo‐Nan; Lin, Chin‐Yu; Chang, Yao‐Ting; Chung, Fa‐Po; Yamada, Shinya; Chen, Shih‐Ann

doi:10.1007/s10840-017-0265-3

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…During mapping in the left ventricle (LV) or coronary cusps, intravenous heparin was used to achieve an activated clotting time more than 250 seconds. The sequence of mapping within the RV, LV, coronary cusp region, and coronary venous system was based on the predicted site of origin according to the ECG PVC morphology . When the targeted PVC was observed during the procedure, activation mapping was performed.…”

Section: Methodsmentioning

confidence: 99%

“…The sequence of mapping within the RV, LV, coronary cusp region, and coronary venous system was based on the predicted site of origin according to the ECG PVC morphology. [12][13][14] When the targeted PVC was observed during the procedure, activation mapping was performed. The activation time was measured from the onset of the bipolar electrogram (earliest positive or negative deflection) from the distal bipole of the mapping catheter to the earliest onset of the QRS complex documented in any of the 12-surface ECG leads.…”

Section: Study Populationmentioning

confidence: 99%

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Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Shirai

Liang

Supple

et al. 2019

Cardiovasc electrophysiol

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Background Catheter ablation (CA) of idiopathic premature ventricular complexes (PVCs) is typically guided by both activation and pace‐mapping, with ablation ideally delivered at the site of the earliest local activation. However, activation mapping requires sufficient intraprocedural quantity of PVCs. This study aimed to investigate the outcome of CA of infrequent PVCs guided exclusively by pace‐mapping. Methods We retrospectively analyzed all patients undergoing CA of idiopathic PVCs between 2014 and 2017. Results Among 327 patients, 24 (7.3%) had low intraprocedural PVC burden despite isoproterenol, including two patients with zero PVCs, rendering activation mapping impractical/impossible. All 24 had a history of symptomatic PVCs. During ablation, a median of 27 (17‐55) pace‐maps were performed, with best median PASO score of 97 (96‐98)%. A median of 12 (8.75‐18.75) radiofrequency (RF) lesions were delivered with 11.4 (8.5‐17.6) minutes of total RF time. Clinical success, defined as more than 80% reduction in the burden of previously frequent PVCs and/or absence of symptoms as well as any documented clinical PVCs among those with infrequent or exercise‐induced PVCs, was achieved in 19 (79%) patients over 9.2 (2.0‐15.0) months of follow‐up. Conclusions When activation mapping cannot be performed due to inadequate intraprocedural PVC burden, detailed pace‐mapping can frequently identify the precise arrhythmia site of origin, thereby guiding successful CA.

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Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Shirai

Liang

Supple

et al. 2019

Cardiovasc electrophysiol

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“…QRS complex duration may be a potential way to distinguish LPF‐IVAs from PPM‐IVAs. The relatively posterior exit location 15 and conduction delay through the PPM into the normal myocardium 8 probably accounts for the duration difference. Yamada 16 et al reported a QRS duration >160 ms as the only predictor for distinguishing PPM‐IVAs from LPF‐IVAs.…”

Section: Discussionmentioning

confidence: 99%

Remote magnetic‐guided ablation for three origins of idiopathic ventricular arrhythmias with right bundle branch block and superior axis

Wen-tao²,

Zhang

et al. 2021

Clinical Cardiology

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Background Idiopathic ventricular arrhythmias (IVAs) with right bundle branch block (RBBB) and superior axis commonly originate from posterior mitral annulus (PMA), the left ventricular (LV) posterior fascicle (LPF), and the LV posterior papillary muscles (PPM). Hypothesis Remote magnetic navigation (RMN)‐guided ablation might be safe and effective for these three origins of IVAs. Methods Thirty consecutive IVA patients with RBBB and superior axis (11 MPA‐IVAs, 11 LPF‐IVAs, and 8 PPM‐IVAs) were included in this study. Electrical mapping and ablation with RMN were performed in the LV through a trans‐septal approach. Navigation index, defined as the ratio of total radiofrequency (RF) time and the time from first burn to last burn, was used to determine the efficiency of RMN‐guided ablation. Results The overall acute success rate was achieved in 93% (PMA, 100%; LPF, 91%; PPM, 88%; p > 0.05). No complication occurred in this study. The procedure time of PPM‐IVAs group was 34 and 14 min longer when compared with MPA‐IVAs and LPF‐IVAs group, respectively, without an increase of X‐ray time. The mean navigation index was 0.45 ± 0.20. The PPM‐IVAs group had an underperforming navigation index value (0.29 ± 0.11) (p < 0.01), as longer RF time was required in the PPM‐IVAs group. Conclusions RMN‐guided ablation can achieve a high acute success rate for IVAs with RBBB and superior axis. The lower navigation index for PPM‐IVAs indicated that increasing the RF time and improving the catheter contact should be considered when using RMN.

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“…However, the ECG features are very similar for PAM and LV fascicular PVCs, and an R/S ratio ≤1 in lead V6 in the LV anterolateral region and a QRS duration >160 ms, and qR or R waves in lead V1 (as compared with an rsR’ for fascicular PVCs) in the LV posteroseptal region may be the only reliable predictors for differentiating PAM PVCs from LV fascicular PVCs . A QRS duration of less than 130 ms strongly suggests fascicular PVCs in both the LV anterolateral and posteroseptal regions …”

Section: Specific Considerationmentioning

confidence: 93%

“…A lot of ECG algorithms for predicting the location of an idiopathic PVC origin have been proposed. [6][7][8][16][17][18][20][21][22]24,26,30,41,42,45,[53][54][55]60 However, most of them were developed to differentiate sites of PVC origins in a specific region such as the ventricular outflow tract, right ventricular His bundle region, and so forth, and they can be less accurate or cannot be used in an ECG diagnosis of overall idiopathic…”

Section: Ecg Algorithmsmentioning

confidence: 99%

Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

Yamada

2019

Cardiovasc electrophysiol

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The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve‐lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients’ physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12‐lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.

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Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

Abstract: The novel algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of the VA-RBB of >36 ms could be useful in differentiating PPM-VAs from LPF-VAs.

Cited by 6 publications

References 12 publications

Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Remote magnetic‐guided ablation for three origins of idiopathic ventricular arrhythmias with right bundle branch block and superior axis

Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

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