Clinical and Electrophysiological Spectrum of Idiopathic Ventricular Outflow Tract Arrhythmias
Robert J. Kim, MD,
Sei Iwai, MD, FACC,
Steven M. Markowitz, MD, FACC,
Bindi K. Shah, MD, FACC,
Kenneth M. Stein, MD, FACC and
Bruce B. Lerman, MD, FACC*
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York
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Figure 1 Comparison of ECG Morphologies of Clinical PVC and Induced Sustained VT From a Patient Who Presented With Repetitive PVCs
(A) 12-lead electrocardiogram (ECG) of a sinus beat followed by a premature ventricular contraction (PVC). (B) 12-lead ECG of induced sustained ventricular tachycardia (VT) from the same patient.
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Figure 2 Electrophysiologic Profile of Induced Sustained VT in a Patient Who Presented With Repetitive PVCs
(A) Induction of sustained ventricular tachycardia (VT) with rapid ventricular pacing from the right ventricular apex (black arrows) during concomitant infusion of isoproterenol (ISO) (same patient as in Fig. 1). Note that the first beat of VT (fourth beat in the figure) represents pseudofusion between a ventricular pacing spike and the first beat of VT, and the fifth ventricular pacing spike (noncapture) occurs after the second beat of VT. (B) Termination of induced sustained VT with adenosine. HRA = high right atrium; PVC = premature ventricular contraction; RVA = right ventricular apex; RVP = right ventricualr pacing.
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Figure 3 Electroanatomic Map of Earliest Site of Activation (Posterior Aspect of RVOT) of PVCs From the Same Patient Shown in Figures 1 and 2
Surface electrocardiogram leads II, aVL, V1, and V6 and unipolar and bipolar electrograms (M1-M2) are shown on the right. LAT = lateral; PA = postero-anterior; PVC = premature ventricular contraction; RVOT = right ventricular outflow tract.
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Figure 4 Identical Morphologies of PVCs, NSVT, and Sustained VT From a Patient With Exercise-Induced VT
The 12-lead surface ECG recordings show identical morphologies of repetitive monomorphic PVCs (A), a 6-beat run of nonsustained ventricular tachycardia (NSVT) (B), and sustained VT (C), all of which occurred consecutively during infusion of isoproterenol. Ablation at the earliest site of activation of the PVC from the left ventricular outflow tract eliminated all 3 forms of arrhythmia. Abbreviations as in Figure 1.
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Figure 5 Relationship of Heart Rate to Frequency of Ectopy From 3 Representative Patients
Data from Holter recordings obtained from (A) a patient who presented with frequent repetitive PVCs showing concordance between increased PVCs (triangles) to higher relative heart rate (squares); (B) a patient who presented with frequent repetitive PVCs showing an inverse relationship between frequency of PVCs (triangles) and heart rate (squares); and (C) a patient who presented with repetitive monomorphic VT showing concordance between increased frequency of PVCs (triangles), runs of VT (circles), and higher heart rate (squares). Number of PVCs and VT runs expressed on log scale (for C only). Note that at hours 1 AM through 3 AM and at 5 AM there were no VT runs. Abbreviations as in Figure 1.
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