CLINICAL STUDY
Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia
Logan Kanagaratnam, MD*,
Gery Tomassoni, MD ,
Robert Schweikert, MD*,
Stephen Pavia, MD*,
Dianna Bash, RN*,
Salwa Beheiry, RN,
Mark Niebauer, MD, PhD*,
Walid Saliba, MD*,
Mina Chung, MD*,
Patrick Tchou, MD* and
Andrea Natale, MD*
* Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Central Baptist Hospital, Lexington, Kentucky, USA
Manuscript received August 18, 2000;
revised manuscript received November 29, 2000,
accepted December 22, 2000.
Reprint requests and correspondence: Dr. Andrea Natale, F15, Section of Cardiac Electrophysiology and Pacing, Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
natalea{at}ccf.org
OBJECTIVES
To describe a normal heart left bundle branch block, inferior axis ventricular tachycardia (VT), that could not be ablated from the right or left ventricular outflow tracts.
BACKGROUND
Whether these VTs are epicardial and can be identified by a specific electrocardiographic pattern is unclear.
METHODS
Twelve patients with normal heart left bundle branch block, inferior axis VT and previously failed ablation were included in this study. Together with mapping in the right and left ventricular outflow tracts, we obtained percutaneous epicardial mapping in the first five patients and performed aortic sinus of Valsalva mapping in all patients.
RESULTS
No adequate pace mapping was observed in the right and left ventricular outflow tracts. Earliest ventricular activation was noted in the epicardium and the aortic cusps. All patients were successfully ablated from the aortic sinuses of Valsalva (95% CI 0% to 18%). The electrocardiographic pattern associated with this VT was left bundle branch block, inferior axis and early precordial transition with Rs or R in V2 or V3. Ventricular tachycardia from the left sinus had rS pattern in lead I, and VT from the noncoronary sinus had a notched R wave in lead I. None of the patients had complications and all remained arrhythmia-free at a mean follow-up of 8 ± 2.6 months.
CONCLUSIONS
Normal heart VT with left bundle branch block, inferior axis and early precordial transition can be ablated in the majority of patients from either the left or the noncoronary aortic sinus of Valsalva.
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Abbreviations and Acronyms
| | ECG | = electrocardiogram | | LBBB | = left bundle branch block | | LVOT | = left ventricular outflow tract | | RVOT | = right ventricular outflow tract | | VT | = ventricular tachycardia |
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