Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery
Yukio Sekiguchi, MD*,*,
Kazutaka Aonuma, MD*,
Atsushi Takahashi, MD*,
Yasuteru Yamauchi, MD*,
Hitoshi Hachiya, MD*,
Yasuhiro Yokoyama, MD*,
Yoshito Iesaka, MD and
Mitsuaki Isobe, MD
* Cardiovascular Center, Yokosuka Kyosai General Hospital, Kanagawa, Japan
Cardiovascular Division, Tsuchiura Kyodo Hospital, Ibaraki, Japan
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Figure 1 Anatomic location of the successful ablation sites in the pulmonary artery group. The successful ablation sites are indicated by the stars ( ), and they were mostly along the septum. Ant. = anterior; AV = aortic valve; MV = mitral valve; PV = pulmonary valve; Rt. = right; TV = tricuspid valve.
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Figure 2 The electrocardiograms of Patients #1 and #2 showing clinical ventricular tachycardias (VTs) originating within the pulmonary artery (PA) (panel I) and the electrocardiogram of Patient #1 showing pace mapping at the successful ablation site within the PA (panel II). In Patient #1, QRS complexes during pacing almost match those of the clinical VT.
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Figure 3 Plots of the R-wave amplitudes on inferior leads (II, III, aVF) in patients with clinical ventricular arrhythmia originating within the pulmonary artery (PA) and those from the endocardial right ventricular outflow tract (RV-end-OT).
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Figure 4 Comparison of electrocardiograms between the pulmonary artery (PA) group and endocardial right ventricular outflow tract (RV-end-OT) group in terms of (A) aVL/aVR ratio of Q-wave amplitude, (B) lead I polarity, (C) precordial R-wave transitional zone, and (D) R/S ratio on lead V2.
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Figure 5 Two intracardiac electrograms that were recorded of a sinus beat and the clinical ventricular arrhythmia at the successful ablation sites in two patients. (A) Earliest ventricular activation precedes onset of the QRS complex by –47 ms in a 39-year-old man (Patient #16) with ventricular tachycardia (VT) originating within the pulmonary artery. The presystolic bipolar potential precedes the unipolar potential by –27 ms, and atrial potentials can be clearly recognized from the mapping catheter (arrow). The amplitude of local ventricular bipolar potential is 0.65 mV. (B) Earliest ventricular activation precedes onset of the QRS complex by –48 ms in a 60-year-old woman with VT originating from the endocardial right ventricular outflow tract. The timing of the presystolic bipolar potential is nearly equal to the onset of the local unipolar potential. The atrial potential cannot be seen from the mapping catheter (arrow). The amplitude of local ventricular bipolar potential is 3.68 mV. bi = bipolar signal; CS = coronary sinus electrogram; LCC = left coronary cusp electrogram; PA = pulmonary artery electrogram; RV-end-OT = endocardial right ventricular outflow tract electrogram; uni = unipolar signal.
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Figure 6 Comparison of intracardiac electrograms between the pulmonary artery (PA) group and the endocardial right ventricular outflow tract (RV-end-OT) group in terms of the amplitude of local ventricular bipolar potentials during sinus rhythm at the successful ablation site. The amplitude in the PA group is significantly lower than that in the RV-end-OT group.
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Figure 7 Right (30°) and left (45°) anterior oblique (RAO and LAO, respectively) radiographic views of the ablation catheter (ABL) within the pulmonary artery. Pulmonary arteriogram reveals that the catheter is positioned at the posteroseptal portion of right ventricular outflow tract, which is above the pulmonary valve. Successful radiofrequency application was performed at this site. His = catheter at the region of the His bundle.
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