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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Idiopathic Ventricular Arrhythmias Originating From the Aortic Root

Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Results of Radiofrequency Catheter Ablation

Takumi Yamada, MD^_*,_*, H. Thomas McElderry, MD^_*, Harish Doppalapudi, MD^_*, Yoshimasa Murakami, MD, Yukihiko Yoshida, MD, Naoki Yoshida, MD, Taro Okada, MD, Naoya Tsuboi, MD, Yasuya Inden, MD^#, Toyoaki Murohara, MD^#, Andrew E. Epstein, MD^_*, Vance J. Plumb, MD^_*, Satinder P. Singh, MD and G. Neal Kay, MD^_*

^_* Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan
Division of Cardiology, Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan
^# Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Manuscript received December 4, 2007; revised manuscript received March 3, 2008, accepted March 4, 2008.

^_* Reprint requests and correspondence: Dr. Takumi Yamada, Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 Third Avenue South, Birmingham, Alabama 35294-0019. (Email: takumi-y{at}fb4.so-net.ne.jp).

Objectives: This study investigated the prevalence and electrocardiographic and electrophysiologic characteristics of aortic root ventricular arrhythmias (VAs).

Background: Idiopathic VAs originating from the ostium of the left ventricle may be ablated at the base of the aortic cusps.

Methods: We studied 265 patients with idiopathic VAs with an inferior QRS-axis morphology.

Results: The successful ablation site was within (or below) the aortic cusps in 44 patients (16.6%). The site of the origin was the left coronary cusp (LCC) in 24 (54.5%), the right coronary cusp (RCC) in 14 (31.8%), the noncoronary cusp (NCC) in 1 (2.3%), and at the junction between the LCC and RCC (L-RCC) in 5 (11.4%) cases. The maximum amplitude of the R-wave in the inferior leads was significantly greater with an LCC than with an RCC origin (p < 0.05). The ratio of the R-wave amplitude in leads II and III was significantly greater with an LCC than with an RCC origin (p < 0.01) and was significantly smaller in the NCC than in the other sites (p < 0.0001). The ventricular deflection in the His bundle electrogram was significantly later relative to the surface QRS with an LCC or L-RCC origin than with an RCC or NCC origin (p < 0.0001). The ratio of the atrial-to-ventricular deflection amplitude was significantly greater in the NCC than in the other sites (p < 0.0001). No other factors predicted the site of origin.

Conclusions: Idiopathic VAs are more common in the LCC than in the RCC and rarely arise from the NCC. The electrocardiogram is useful for differentiating the site of origin.

Key Words: ventricular arrhythmia • aortic root • prevalence • characteristics • radiofrequency catheter ablation

Abbreviations and Acronyms   ASC = aortic sinus cusp   HB = His bundle   LCC = left coronary cusp   L-RCC = junction between the left and right coronary cusps   LV = left ventricular   LVOT = left ventricular outflow tract   NCC = noncoronary cusp   PVC = premature ventricular contraction   RCC = right coronary cusp   RV = right ventricular   RVOT = right ventricular outflow tract   VA = ventricular arrhythmia   VT = ventricular tachycardia

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