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

59 Citations (Scopus)

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

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

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Sinus of Valsalva
Cardiac Arrhythmias
Veins
Electrocardiography
Endocardium
Tachycardia

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)

Cite this

Jauregui Abularach, M. E., Campos, B., Park, K. M., Tschabrunn, C. M., Frankel, D. S., Park, R. E., ... 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

Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region : ECG features, anatomic distance, and outcome. / Jauregui Abularach, Miguel E.; Campos, Bieito; Park, Kyoung Min; Tschabrunn, Cory M.; Frankel, David S.; Park, Robert E.; Gerstenfeld, Edward P.; Mountantonakis, Stavros; Garcia, Fermin C.; Dixit, Sanjay; Tzou, Wendy S.; Hutchinson, Mathew D.; Lin, David; Riley, Michael P.; Cooper, Joshua M.; Bala, Rupa; Callans, David J.; Marchlinski, Francis E.

In: Heart Rhythm, Vol. 9, No. 6, 06.2012, p. 865-873.

Research output: Contribution to journalArticle

Jauregui Abularach, ME, Campos, B, Park, KM, Tschabrunn, CM, Frankel, DS, Park, RE, Gerstenfeld, EP, Mountantonakis, S, Garcia, FC, Dixit, S, Tzou, WS, Hutchinson, MD, Lin, D, Riley, MP, Cooper, JM, Bala, R, Callans, DJ & Marchlinski, FE 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, vol. 9, no. 6, pp. 865-873. https://doi.org/10.1016/j.hrthm.2012.01.022
Jauregui Abularach, Miguel E. ; Campos, Bieito ; Park, Kyoung Min ; Tschabrunn, Cory M. ; Frankel, David S. ; Park, Robert E. ; Gerstenfeld, Edward P. ; Mountantonakis, Stavros ; Garcia, Fermin C. ; Dixit, Sanjay ; Tzou, Wendy S. ; Hutchinson, Mathew D. ; Lin, David ; Riley, Michael P. ; Cooper, Joshua M. ; Bala, Rupa ; Callans, David J. ; Marchlinski, Francis E. / Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region : ECG features, anatomic distance, and outcome. In: Heart Rhythm. 2012 ; Vol. 9, No. 6. pp. 865-873.
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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",
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T1 - Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region

T2 - ECG features, anatomic distance, and outcome

AU - Jauregui Abularach, Miguel E.

AU - Campos, Bieito

AU - Park, Kyoung Min

AU - Tschabrunn, Cory M.

AU - Frankel, David S.

AU - Park, Robert E.

AU - Gerstenfeld, Edward P.

AU - Mountantonakis, Stavros

AU - Garcia, Fermin C.

AU - Dixit, Sanjay

AU - Tzou, Wendy S.

AU - Hutchinson, Mathew D.

AU - Lin, David

AU - Riley, Michael P.

AU - Cooper, Joshua M.

AU - Bala, Rupa

AU - Callans, David J.

AU - Marchlinski, Francis E.

PY - 2012/6

Y1 - 2012/6

N2 - 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

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KW - Coronary venous system

KW - Left sinus of Valsalva

KW - Left ventricular outflow tract

KW - Ventricular tachycardia ablation

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