Ventricular arrhythmias from the coronary venous system

Prevalence, mapping, and ablation

Stavros E. Mountantonakis, David S. Frankel, Cory M. Tschabrunn, Mathew D. Hutchinson, Michael P. Riley, David Lin, Rupa Bala, Fermin C. Garcia, Sanjay Dixit, David J. Callans, Erica S. Zado, Francis E. Marchlinski

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs). Objective The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS. Methods Detailed activation and pace-mapping of the right ventricle (RV), left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation. Results Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 ± 15) had earliest activation in the CVS, 39 ± 18 ms before QRS. Twenty-five (53%) were in the great cardiac vein, 19 (40%) in the anterior interventricular vein, and 3 (7%) in the middle cardiac vein. We ablated inside CVS in 32 patients (68%) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32%), who underwent ablation from adjacent left sinus of Valsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94%) ablated at the earliest CVS site and in 16 of 29 (55%) ablated at adjacent CVS or non-CVS sites. Conclusion Idiopathic VAs are occasionally (9%) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62%) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55% of these anatomically challenging cases, for an overall ablation success rate of 70%.

Original languageEnglish (US)
Pages (from-to)1145-1153
Number of pages9
JournalHeart Rhythm
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Fingerprint

Heart Ventricles
Cardiac Arrhythmias
Veins
Coronary Vessels
Endocardium
Sinus of Valsalva
Catheter Ablation
Pericardium
Catheters

Keywords

  • Catheter ablation
  • Coronary venous system
  • Ventricular premature depolarization
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mountantonakis, S. E., Frankel, D. S., Tschabrunn, C. M., Hutchinson, M. D., Riley, M. P., Lin, D., ... Marchlinski, F. E. (2015). Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation. Heart Rhythm, 12(6), 1145-1153. https://doi.org/10.1016/j.hrthm.2015.03.009

Ventricular arrhythmias from the coronary venous system : Prevalence, mapping, and ablation. / Mountantonakis, Stavros E.; Frankel, David S.; Tschabrunn, Cory M.; Hutchinson, Mathew D.; Riley, Michael P.; Lin, David; Bala, Rupa; Garcia, Fermin C.; Dixit, Sanjay; Callans, David J.; Zado, Erica S.; Marchlinski, Francis E.

In: Heart Rhythm, Vol. 12, No. 6, 01.06.2015, p. 1145-1153.

Research output: Contribution to journalArticle

Mountantonakis, SE, Frankel, DS, Tschabrunn, CM, Hutchinson, MD, Riley, MP, Lin, D, Bala, R, Garcia, FC, Dixit, S, Callans, DJ, Zado, ES & Marchlinski, FE 2015, 'Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation', Heart Rhythm, vol. 12, no. 6, pp. 1145-1153. https://doi.org/10.1016/j.hrthm.2015.03.009
Mountantonakis SE, Frankel DS, Tschabrunn CM, Hutchinson MD, Riley MP, Lin D et al. Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation. Heart Rhythm. 2015 Jun 1;12(6):1145-1153. https://doi.org/10.1016/j.hrthm.2015.03.009
Mountantonakis, Stavros E. ; Frankel, David S. ; Tschabrunn, Cory M. ; Hutchinson, Mathew D. ; Riley, Michael P. ; Lin, David ; Bala, Rupa ; Garcia, Fermin C. ; Dixit, Sanjay ; Callans, David J. ; Zado, Erica S. ; Marchlinski, Francis E. / Ventricular arrhythmias from the coronary venous system : Prevalence, mapping, and ablation. In: Heart Rhythm. 2015 ; Vol. 12, No. 6. pp. 1145-1153.
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abstract = "Background The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs). Objective The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS. Methods Detailed activation and pace-mapping of the right ventricle (RV), left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation. Results Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 ± 15) had earliest activation in the CVS, 39 ± 18 ms before QRS. Twenty-five (53{\%}) were in the great cardiac vein, 19 (40{\%}) in the anterior interventricular vein, and 3 (7{\%}) in the middle cardiac vein. We ablated inside CVS in 32 patients (68{\%}) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32{\%}), who underwent ablation from adjacent left sinus of Valsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94{\%}) ablated at the earliest CVS site and in 16 of 29 (55{\%}) ablated at adjacent CVS or non-CVS sites. Conclusion Idiopathic VAs are occasionally (9{\%}) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62{\%}) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55{\%} of these anatomically challenging cases, for an overall ablation success rate of 70{\%}.",
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T1 - Ventricular arrhythmias from the coronary venous system

T2 - Prevalence, mapping, and ablation

AU - Mountantonakis, Stavros E.

AU - Frankel, David S.

AU - Tschabrunn, Cory M.

AU - Hutchinson, Mathew D.

AU - Riley, Michael P.

AU - Lin, David

AU - Bala, Rupa

AU - Garcia, Fermin C.

AU - Dixit, Sanjay

AU - Callans, David J.

AU - Zado, Erica S.

AU - Marchlinski, Francis E.

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N2 - Background The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs). Objective The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS. Methods Detailed activation and pace-mapping of the right ventricle (RV), left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation. Results Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 ± 15) had earliest activation in the CVS, 39 ± 18 ms before QRS. Twenty-five (53%) were in the great cardiac vein, 19 (40%) in the anterior interventricular vein, and 3 (7%) in the middle cardiac vein. We ablated inside CVS in 32 patients (68%) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32%), who underwent ablation from adjacent left sinus of Valsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94%) ablated at the earliest CVS site and in 16 of 29 (55%) ablated at adjacent CVS or non-CVS sites. Conclusion Idiopathic VAs are occasionally (9%) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62%) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55% of these anatomically challenging cases, for an overall ablation success rate of 70%.

AB - Background The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs). Objective The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS. Methods Detailed activation and pace-mapping of the right ventricle (RV), left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation. Results Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 ± 15) had earliest activation in the CVS, 39 ± 18 ms before QRS. Twenty-five (53%) were in the great cardiac vein, 19 (40%) in the anterior interventricular vein, and 3 (7%) in the middle cardiac vein. We ablated inside CVS in 32 patients (68%) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32%), who underwent ablation from adjacent left sinus of Valsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94%) ablated at the earliest CVS site and in 16 of 29 (55%) ablated at adjacent CVS or non-CVS sites. Conclusion Idiopathic VAs are occasionally (9%) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62%) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55% of these anatomically challenging cases, for an overall ablation success rate of 70%.

KW - Catheter ablation

KW - Coronary venous system

KW - Ventricular premature depolarization

KW - Ventricular tachycardia

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