Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome

Miguel E. Jauregui Abularach, Bieito Campos, Kyoung Min Park, Cory M. Tschabrunn, David S. Frankel, Robert E. Park, Edward P. Gerstenfeld, Stavros Mountantonakis, Fermin C. Garcia, Sanjay Dixit, Wendy S. Tzou, Mathew D. Hutchinson, David Lin, Michael P. Riley, Joshua M. Cooper, Rupa Bala, David J. Callans, Francis E. Marchlinski

Research output: Contribution to journalArticle

76 Scopus citations

Abstract

Background: Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system. Objective: To describe the characteristics of an alternative successful ablation strategy targeting the left sinus of Valsalva (LSV) and/or the adjacent left ventricular (LV) endocardium. Methods: Of 276 patients undergoing mapping/ablation for outflow tract VT/VPDs, 16 consecutive patients (8 men; mean age 52 ± 17 years) had an ablation attempt from the LSV and/or the adjacent LV endocardium for VT/VPDs mapped marginally closer to the distal great cardiac vein (GCV) or anterior interventricular vein (AIV). Results: Successful ablation was achieved in 9 of the 16 patients (56%) targeting the LSV (5 patients), adjacent LV endocardium (2 patients), or both (2 patients). The R-wave amplitude ratio in lead III/II and the Q-wave amplitude ratio in aVL/aVR were smaller in the successful group (1.05 ± 0.13 vs 1.34 ± 0.37 and 1.24 ± 0.42 vs 2.15 ± 1.05, respectively; P =.043 for both). The anatomical distance from the earliest GCV/AIV site to the closest point in the LSV region was shorter for the successful group (11.0 ± 6.5 mm vs 20.4 ± 12.1 mm; P =.048). A Q-wave ratio of <1.45 in aVL/aVR and an anatomical distance of <13.5 mm had sensitivity and specificity of 89%, 75% and 78%, 64%, respectively, for the identification of successful ablation. Conclusions: VT/VPDs originating near the GCV/AIV can be ablated from the LSV/adjacent LV endocardium. A Q-wave ratio of <1.45 in aVL/aVR and a close anatomical distance of <13.5 mm help identify appropriate candidates.

Original languageEnglish (US)
Pages (from-to)865-873
Number of pages9
JournalHeart Rhythm
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2012

Keywords

  • Coronary venous system
  • Left sinus of Valsalva
  • Left ventricular outflow tract
  • Ventricular tachycardia ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome'. Together they form a unique fingerprint.

  • Cite this

    Jauregui Abularach, M. E., Campos, B., Park, K. M., Tschabrunn, C. M., Frankel, D. S., Park, R. E., Gerstenfeld, E. P., Mountantonakis, S., Garcia, F. C., Dixit, S., Tzou, W. S., Hutchinson, M. D., Lin, D., Riley, M. P., Cooper, J. M., Bala, R., Callans, D. J., & Marchlinski, F. E. (2012). Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart Rhythm, 9(6), 865-873. https://doi.org/10.1016/j.hrthm.2012.01.022