Document Detail

Electrophysiologic Characteristics of Ventricular Arrhythmias Arising From the Aortic Mitral Continuity - Potential Role of the Conduction System.
MedLine Citation:
PMID:  25425429     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown.
METHODS: Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate.
RESULTS: Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs) (26.1 ± 10.9% vs 14.9 ± 10.1%, p = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 ms vs 33.1 ± 8.8 ms, p = 0.03), lower pace map scores (8.7 ± 1.6 vs 11.4 ± 0.8, p = 0.001), and a trend towards shorter V-H intervals during VA (32.1 ± 38.6 ms vs 76.3 ± 11.1 ms, p = 0.06) as compared to those without PP. A strong and positive correlation was found between V-H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R(2) = 0.97, t = 13.7, p <0.001) but not in those without PPs.
CONCLUSION: Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success. This article is protected by copyright. All rights reserved.
Jo Jo Hai; Anwar A Chahal; Paul A Friedman; Vaibhav R Vaidya; Faisal F Syed; Christopher V DeSimone; Sudip Nanda; Peter A Brady; Malini Madhavan; Yong-Mei Cha; Christopher J McLeod; Siva Mulpuru; Thomas M Munger; Douglas L Packer; Samuel J Asirvatham
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-26
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-26     Completed Date:  -     Revised Date:  2014-11-27    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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