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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Outflow tract tachycardia with R/S transition in lead V₃

Six different anatomic approaches for successful ablation

University of Leipzig-Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany

Manuscript received August 10, 2004; revised manuscript received October 2, 2004, accepted October 4, 2004.

^* Reprint requests and correspondence: Dr. Hildegard Tanner, University of Leipzig, Heart Center, Cardiology, Dept. of Electrophysiology, Struempellstrasse 39, D-04289 Leipzig, Germany (Email: hilditanner{at}pop.agri.ch).

OBJECTIVES: The aim of this study was to analyze different anatomic mapping approaches for successful ablation of outflow tract tachycardia with R/S transition in lead V₃.

BACKGROUND: Idiopathic ventricular tachycardia can originate from different areas in the outflow tract, including the right and left ventricular endocardium, the epicardium, the pulmonary artery, and the aortic sinus of Valsalva. Although electrocardiographic criteria may be helpful in predicting the area of origin, sometimes the focus is complex to determine, especially when QRS transition in precordial leads is in V₃.

METHODS: We analyzed surface electrocardiograms of 33 successfully ablated patients with outflow tract tachycardia: 20 from the right ventricular outflow tract (RVOT) and 13 from different sites. The R/S transition was determined, and the different anatomic approaches needed for successful catheter ablation were studied.

RESULTS: Overall, R/S transition in lead V₃ was present in 19 (58%) of all patients. In these patients, mapping was started and successfully completed in the RVOT in 11 of 19 (58%) patients. The remaining eight patients with R/S transition in lead V₃ needed five additional anatomic accesses for successful ablation: from the left ventricular outflow tract (n = 3), aortic sinus of Valsalva (n = 2), coronary sinus (n = 1), the epicardium via pericardial puncture (n = 1), and the trunk of the pulmonary artery (n = 1), respectively.

CONCLUSIONS: A R/S transition in lead V₃ is common. In patients with outflow tract tachycardia with R/S transition in lead V₃, a stepwise endocardial and epicardial mapping through up to six anatomic approaches can lead to successful radiofrequency catheter ablation.

Abbreviations and Acronyms   ECG = electrocardiogram   LVOT = left ventricular outflow tract   RF = radiofrequency   RVOT = right ventricular outflow tract   VT = ventricular tachycardia

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