Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure

Rupa Bala, Fermin C. Garcia, Mathew D. Hutchinson, Edward P. Gerstenfeld, Sandhya Dhruvakumar, Sanjay Dixit, Joshua M. Cooper, David Lin, John Harding, Michael P. Riley, Erica Zado, David J. Callans, Francis E. Marchlinski

Research output: Contribution to journalArticle

87 Scopus citations

Abstract

Background: Ventricular arrhythmias are known to originate from the aortic sinus of Valsalva. Objective: The purpose of this study was to identify the characteristics associated with ventricular arrhythmias originating from the right coronary cusp-left coronary cusp (RCC-LCC) commissure. Methods: Thirty-seven consecutive patients with ventricular arrhythmias originating from the aortic cusp region were studied. Intracardiac echocardiography and electroanatomic mapping were used to define coronary cusp anatomy and catheter position. Ventricular arrhythmias from the RCC-LCC commissure were compared with ventricular arrhythmias originating from other sites in the aortic cusp region. Results: Nineteen (51%) ventricular arrhythmias had an anatomic origin at the RCC-LCC commissure. Eighteen ventricular arrhythmias originated from other aortic cusp sites (4 right cusp, 7 left cusp, 3 left ventricular endocardium, 4 left ventricular epicardium anterior to aortic valve). A QS morphology in lead V1 with notching on the downward deflection was present in 15 of 19 ventricular arrhythmias originating from the RCC-LCC commissure compared to 2 of 18 ventricular arrhythmias from other aortic cusp sites (P <.01). At the site of earliest activation, 13 of 19 patients with RCC-LCC ventricular arrhythmias had late potentials in sinus rhythm compared to 1 of 18 ventricular arrhythmias from other aortic cusp sites (P <.01). The site of successful ablation was confirmed to be above the aortic valve plane in 15 (79%) of 19 patients with RCC-LCC ventricular arrhythmias. Conclusion: RCC-LCC aortic cusp ventricular arrhythmias are common and have a QS morphology in lead V1 with notching on the downward deflection with precordial transition at lead V3. In the majority of cases, the site of successful ablation has late potentials in sinus rhythm.

Original languageEnglish (US)
Pages (from-to)312-322
Number of pages11
JournalHeart Rhythm
Volume7
Issue number3
DOIs
StatePublished - Mar 1 2010

Keywords

  • Catheter ablation
  • Echocardiography
  • Electrophysiology
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure'. Together they form a unique fingerprint.

  • Cite this

    Bala, R., Garcia, F. C., Hutchinson, M. D., Gerstenfeld, E. P., Dhruvakumar, S., Dixit, S., Cooper, J. M., Lin, D., Harding, J., Riley, M. P., Zado, E., Callans, D. J., & Marchlinski, F. E. (2010). Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm, 7(3), 312-322. https://doi.org/10.1016/j.hrthm.2009.11.017