Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics and treatment by catheter ablation

Mouhannad M. Sadek, Daniel Benhayon, Ravi Sureddi, William Chik, Pasquale Santangeli, Gregory E. Supple, Mathew D. Hutchinson, Rupa Bala, Lidia Carballeira, Erica S. Zado, Vickas V. Patel, David J. Callans, Francis E. Marchlinski, Fermin C. Garcia

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.

Original languageEnglish (US)
Pages (from-to)67-75
Number of pages9
JournalHeart Rhythm
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Catheter Ablation
Ventricular Premature Complexes
Cardiac Arrhythmias
Ventricular Tachycardia
Bundle-Branch Block
Therapeutics
Echocardiography
Anti-Arrhythmia Agents
Ventricular Fibrillation
Drug Therapy

Keywords

  • Catheter ablation
  • Idiopathic ventricular fibrillation
  • Intracardiac echocardiography
  • Moderator band
  • Premature ventricular contractions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Idiopathic ventricular arrhythmias originating from the moderator band : Electrocardiographic characteristics and treatment by catheter ablation. / Sadek, Mouhannad M.; Benhayon, Daniel; Sureddi, Ravi; Chik, William; Santangeli, Pasquale; Supple, Gregory E.; Hutchinson, Mathew D.; Bala, Rupa; Carballeira, Lidia; Zado, Erica S.; Patel, Vickas V.; Callans, David J.; Marchlinski, Francis E.; Garcia, Fermin C.

In: Heart Rhythm, Vol. 12, No. 1, 01.01.2015, p. 67-75.

Research output: Contribution to journalArticle

Sadek, MM, Benhayon, D, Sureddi, R, Chik, W, Santangeli, P, Supple, GE, Hutchinson, MD, Bala, R, Carballeira, L, Zado, ES, Patel, VV, Callans, DJ, Marchlinski, FE & Garcia, FC 2015, 'Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics and treatment by catheter ablation', Heart Rhythm, vol. 12, no. 1, pp. 67-75. https://doi.org/10.1016/j.hrthm.2014.08.029
Sadek, Mouhannad M. ; Benhayon, Daniel ; Sureddi, Ravi ; Chik, William ; Santangeli, Pasquale ; Supple, Gregory E. ; Hutchinson, Mathew D. ; Bala, Rupa ; Carballeira, Lidia ; Zado, Erica S. ; Patel, Vickas V. ; Callans, David J. ; Marchlinski, Francis E. ; Garcia, Fermin C. / Idiopathic ventricular arrhythmias originating from the moderator band : Electrocardiographic characteristics and treatment by catheter ablation. In: Heart Rhythm. 2015 ; Vol. 12, No. 1. pp. 67-75.
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T1 - Idiopathic ventricular arrhythmias originating from the moderator band

T2 - Electrocardiographic characteristics and treatment by catheter ablation

AU - Sadek, Mouhannad M.

AU - Benhayon, Daniel

AU - Sureddi, Ravi

AU - Chik, William

AU - Santangeli, Pasquale

AU - Supple, Gregory E.

AU - Hutchinson, Mathew D.

AU - Bala, Rupa

AU - Carballeira, Lidia

AU - Zado, Erica S.

AU - Patel, Vickas V.

AU - Callans, David J.

AU - Marchlinski, Francis E.

AU - Garcia, Fermin C.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.

AB - BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.

KW - Catheter ablation

KW - Idiopathic ventricular fibrillation

KW - Intracardiac echocardiography

KW - Moderator band

KW - Premature ventricular contractions

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