Idiopathic ventricular tachycardia cured by radiofrequency application from the distal great cardiac vein and the left coronary cusp

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

Background

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).

Methods

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.

Results

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.

Conclusion

A “w” pattern in lead I may distinguish distal GCV VAs from VAs arising from the LCC or the subvalvular region.

Electronic supplementary material

The online version of this article (10.1186/s12872-019-1064-9) contains supplementary material, which is available to authorized users.

A case of premature ventricular complexes/ventricular tachycardia from the left ventricular outflow tract successfully ablated from the distal great cardiac vein

We experienced a 41-year-old male with premature ventricular complexes/ventricular tachycardia from the left coronary cusp and distal great cardiac vein of the left ventricular outflow tract successfully treated by radiofrequency catheter ablation utilizing a 3D mapping system (EnSiteNavX/Velocity™ Cardiac Mapping System, St. Jude Medical, St. Paul, MN, USA) without any complications. <Learning objective: The approach from the distal great cardiac vein should be considered as a potential approach and may be one of the effective strategies for ablation of left ventricular outflow tract-premature ventricular complexes/ventricular tachycardia (PVC/VTs). Radiofrequency catheter ablation of frequent PVC/VTs may improve the clinical status and cardiac function.>.

[Localization of the origin of idiopathic ventricular extrasystoles and tachycardia from the outflow tract]

Premature ventricular contractions (PVC) are a common cause for complaints. As a rule PVCs are not life-threatening if no structural heart disease is present; however, due to the symptoms treatment is often required using either antiarrhythmic drugs or more commonly catheter ablation. The surface electrocardiogram (ECG) is very helpful in localizing the origin of the arrhythmia, in particular for differentiating right from left ventricular sources.

Adenosine sensitivity is associated with ablation success rate and recurrence rate with nonirrigated catheters in patients with ventricular premature contractions/tachycardia from the ventricular outflow tract

BACKGROUND

A high ablation success rate for ventricular arrhythmia (VA) from outflow tract has been achieved, but some of them cannot be eliminated from endocardium. We investigated the association between adenosine sensitivity and ablation success/recurrence rates with a nonirrigated or an irrigated catheter.

METHODS

According to adenosine test, all patients were divided into a sensitive group (S group) or an insensitive group (I group). The patients of each group were randomized into a nonirrigated catheter (NA) subgroup or an irrigated catheter (IA) subgroup with a 2:1 ratio.

RESULTS

In S group of 122 patients (84 in NA subgroup), the ablation success rate was similar between two subgroups (94.7% vs. 90.5%, P > 0.05), but in I group of 94 patients (60 in NA subgroup), it was higher in IA subgroup (94.1%) than that in NA subgroup (73.3%, P < 0.05). The success rate using nonirrigated catheter was significantly higher in S group (90.5%) than that in I group (73.3%, P < 0.01), and the recurrence rate was lower in S group than that in I group (1.3%, vs. 13.6%, P < 0.05). On the contrary, the success rate and the recurrence rate using irrigated catheter were similar between S group and I group (94.7%, 94.1%, P > 0.05, vs. 2.8%, 6.3%, P > 0.05).

CONCLUSIONS

Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation. Thus, irrigated catheters should be the first choice for VA ablation in adenosine insensitive patients.