Unique electrocardiographic pattern “w” wave in lead I of idiopathic ventricular arrhythmias arising from the distal great cardiac vein

• Published in: BMC cardiovascular disorders Vol. 19; no. 1; pp. 90 - 8
• Main Authors: Li, Teng, Xu, Qiong, Zhan, Xian-zhang, Xue, Yu-mei, Liao, Hong-tao, Li, Yi-fu, Letsas, Konstantinos P., Wu, Shu-lin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.04.2019; BioMed Central; BMC
• Subjects: Ablation (Surgery); Action Potentials; Adult; Aged; Aorta; Arrhythmia; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - surgery; Bundle-Branch Block - diagnosis; Bundle-Branch Block - physiopathology; Bundle-Branch Block - surgery; Cardiac arrhythmia; Catheter Ablation; Catheters; Coronary Sinus - physiopathology; Coronary Sinus - surgery; Coronary vessels; Diagnosis; EKG; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Great cardiac vein; Heart; Heart Rate; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; Idiopathic; Male; Medical imaging; Middle Aged; Population studies; Predictive Value of Tests; Progression-Free Survival; Risk factors; Time Factors; Veins & arteries; Ventricle; Ventricular aneurysm; Ventricular arrhythmias; United States > US; Ventricular arrhythmias; Great cardiac vein; Catheter ablation; Idiopathic
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-019-1064-9

The ECG characteristics of the distal coronary venous system ventricular arrhythmias (VAs) share common features with VAs arising from the aortic cusps or the endocardial left ventricular outflow tract (LVOT) beneath the cusps. The purpose of this study was to identify specific electrocardiographic and electrophysiological characteristics of VAs originating from the distal great cardiac vein (GCV). Based on the successful ablation site, patients with idiopathic VAs from the distal GCV, left coronary cusp (LCC) or the subvalvular left ventricular outflow tract (LVOT) area were included in the present study. The final population consisted of 39 patients (35 males, mean age 51 ± 23 years). All VAs displayed a right bundle branch block (RBBB) morphology with inferior axis. Among these patients, 15 were successfully ablated at the GCV, 15 at the LCC and 9 at the subvalvular region. A "w" pattern in lead I was present in 12 out of 15 (80%) VAs originating from the distal GCV compared to none of VAs arising from the other two sites (p < 0.01). VAs with a GCV origin exhibited more commonly increased intrinsicoid deflection time, higher maximum deflection index and wider QRS duration compared to LCC and subvalvular sites (p < 0.05). Acceptable pace mapping at the successful ablation site was achieved in 10 patients. After an average of 36 ± 24 months follow up, 14 (93.3%) patients were free from VAs recurrence. A "w" pattern in lead I may distinguish distal GCV VAs from VAs arising from the LCC or the subvalvular region.