Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: Electrocardiographic characteristics and correlative anatomy

• Published in: Heart rhythm Vol. 13; no. 1; pp. 111 - 121
• Main Authors: Lin, Chin-Yu, MD, Chung, Fa-Po, MD, Lin, Yenn-Jiang, MD, PhD, Chong, Eric, MBBS, Chang, Shih-Lin, MD, PhD, Lo, Li-Wei, MD, PhD, Hu, Yu-Feng, MD, PhD, Tuan, Ta-Chuan, MD, Chao, Tze-Fan, MD, Liao, Jo-Nan, MD, Chang, Yao-Ting, MD, Chen, Yun-Yu, MPH, Chen, Chun-Ku, MD, Chiou, Chuen-Wang, MD, Chen, Shih-Ann, MD, Tsao, Hsuan-Ming, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Ablation; Adult; Algorithms; Aortic sinus of Valsalva; Cardiovascular; Catheter Ablation - methods; Electrocardiography; Electrocardiography - methods; Electrophysiological Phenomena; Female; Heart Ventricles - physiopathology; Humans; Left ventricular summit; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Sinus of Valsalva - physiopathology; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Treatment Outcome; Ventricular arrhythmia; ventricular arrhythmia; PdW; radiofrequency; intrinsicoid deflection time; LV; LVOT; RVOT; right ventricular outflow tract; MDI; maximum deflection index; electrocardiography/electrocardiographic; GCV/AIV; IDT; Electrocardiography; left ventricle/ventricular; receiver operating characteristic; 3-dimensional; pseudo-delta wave; great cardiac vein/anterior interventricular vein; ASV; aortic sinus of Valsalva; ROC; ECG; left ventricular outflow tract; radiofrequency catheter ablation; VA; Ablation; 3D; RF; RFCA; ventricular tachycardia; Left ventricular summit; PVC; premature ventricular complex; VT; Ventricular arrhythmia; Aortic sinus of Valsalva
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2015.08.030

Background Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge. Objectives The objectives of this study were to investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and to develop an algorithm for predicting the successful ablation site. Methods We recruited 66 patients (mean age, 47 ± 15 years; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and the LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n = 20; group 2: subvalvular region, n = 15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n = 16; group 4: epicardium requiring pericardial access, n = 15). The QRS morphological characteristics of VAs were compared between the 4 groups. Results Electrocardiographic analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cutoff values of ≤1.415, 1.416–1.535, 1.536–1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated with the distance between the successful ablation site and the tip of the LV summit. A distance of >18.9 mm and an LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight patients (12.1%) developed VA recurrence during a mean follow-up of 15.9 months (interquartile range 9.2–24.2 months). Conclusion The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and the LV summit.