CLINICAL STUDY: ELECTROPHYSIOLOGY
Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp
Electrocardiographic characterization for guiding catheter ablation
Feifan Ouyang, MD*,*,
Parwis Fotuhi, MD*,
Siew Yen Ho, PhD ,
Joachim Hebe, MD*,
Marius Volkmer, MD*,
Masahiko Goya, MD*,
Mark Burns, MD*,
Matthias Antz, MD*,
Sabine Ernst, MD*,
Riccardo Cappato, MD* and
Karl-Heinz Kuck, MD*
* II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
Department of Paediatrics, National Heart and Lung Institute and Royal Brompton Hospital, Imperial College School of Medicine, London, United Kingdom
Manuscript received July 25, 2001;
revised manuscript received October 15, 2001,
accepted November 1, 2001.
* Reprint requests and correspondence: Dr. Feifan Ouyang, Allgemeines Krankenhaus St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
Ouyangfeifan{at}aol.com
OBJECTIVES: We sought to investigate the electrocardiographic (ECG) characteristics for guiding catheter ablation in patients with repetitive monomorphic ventricular tachycardia (RMVT) originating from the aortic sinus cusp (ASC).
BACKGROUND: Repetitive monomorphic ventricular tachycardia can originate from the right ventricular outflow tract (RVOT) and ASC in patients with a left bundle branch block (LBBB) morphology and an inferior axis.
METHODS: Activation mapping and ECG analysis was performed in 15 patients with RMVT or ventricular premature contractions. The left main coronary artery (LMCA) was cannulated as a marker and for protection during radiofrequency delivery if RMVT originated from the left coronary ASC.
RESULTS: During arrhythmia, the earliest ventricular activation was recorded from the superior septal RVOT in eight patients (group 1) and from the ASC in the remaining seven patients (group 2). The indexes of R-wave duration and R/S-wave amplitude were significantly lower in group 1 than in group 2 (31.8 ± 13.5% vs. 58.3 ± 12.1% and 14.9 ± 9.9% vs. 56.7 ± 29.5%, respectively; p < 0.01), despite similar QRS morphology. In five patients from group 2, RMVT originated from the left ASC, with a mean distance of 12.2 ± 3.2 mm (range 7.3 to 16.1) below the ostium of the LMCA. In the remaining two patients, the RMVT origin was in the right ASC. All arrhythmias were successfully abolished. None of the patients had recurrence or complications during 9 ± 3 months of follow-up.
CONCLUSIONS: On the surface ECG, RMVT from the ASC has a QRS morphology similar to that of RVOT arrhythmias. The indexes of R-wave duration and R/S-wave amplitude can be used to differentiate between the two origins. Radiofrequency ablation can be safely performed within the left ASC with a catheter cannulating the LMCA.
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Abbreviations and Acronyms
| | LMCA | | ASC | | aortic sinus cusp | | ECG | | electrocardiogram or electrocardiographic | | LBBB | | left bundle branch block | | LMCA | | left main coronary artery | | RCA | | right coronary artery | | RF | | radiofrequency | | RMVT | | repetitive monomorphic ventricular tachycardia | | RVOT | | right ventricular outflow tract | | VPC | | ventricular premature contraction |
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