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Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: Electrocardiographic characteristics and correlative anatomy.
- Source :
-
Heart rhythm [Heart Rhythm] 2016 Jan; Vol. 13 (1), pp. 111-21. Date of Electronic Publication: 2015 Aug 21. - Publication Year :
- 2016
-
Abstract
- Background: Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge.<br />Objectives: The objectives of this study were to investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and to develop an algorithm for predicting the successful ablation site.<br />Methods: We recruited 66 patients (mean age, 47 ± 15 years; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and the LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n = 20; group 2: subvalvular region, n = 15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n = 16; group 4: epicardium requiring pericardial access, n = 15). The QRS morphological characteristics of VAs were compared between the 4 groups.<br />Results: Electrocardiographic analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cutoff values of ≤1.415, 1.416-1.535, 1.536-1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated with the distance between the successful ablation site and the tip of the LV summit. A distance of >18.9 mm and an LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight patients (12.1%) developed VA recurrence during a mean follow-up of 15.9 months (interquartile range 9.2-24.2 months).<br />Conclusion: The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and the LV summit.<br /> (Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Algorithms
Electrophysiological Phenomena
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Treatment Outcome
Catheter Ablation methods
Electrocardiography methods
Heart Ventricles physiopathology
Sinus of Valsalva physiopathology
Tachycardia, Ventricular diagnosis
Tachycardia, Ventricular etiology
Tachycardia, Ventricular physiopathology
Tachycardia, Ventricular surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 13
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 26304712
- Full Text :
- https://doi.org/10.1016/j.hrthm.2015.08.030