Document Detail


Idiopathic left ventricular arrhythmias originating adjacent to the left aortic sinus of valsalva: electrophysiological rationale for the surface electrocardiogram.
MedLine Citation:
PMID:  19804552     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV. METHODS AND RESULTS: We studied 48 consecutive patients undergoing successful catheter ablation of idiopathic VAs originating from the left coronary cusp (LCC, n = 29), aortomitral continuity (AMC, n = 10) and great cardiac vein or anterior interventricular cardiac vein (Epi, n = 9). A small r wave, or rarely an R wave, was typically observed in lead I during the VAs and pacing in these regions. An S wave in lead V5 or V6 occurred significantly more often during both the VAs and pacing from the AMC than during that from the LCC and Epi (p < 0.05 to 0.0001). For discriminating whether VA origins can be ablated endocardially or epicardially, the maximum deflection index (MDI = the shortest time to the maximum deflection in any precordial lead/QRS duration) was reliable for VAs arising from the AMC (100%), but was less reliable for LCC (73%) and Epi (67%) VAs. In 3 (33%) of the Epi VAs, the site of an excellent pace map was located transmurally opposite to the successful ablation site (LCC = 1 and AMC = 2). CONCLUSIONS: The MDI has limited value for discriminating endocardial from epicardial VA origins in sites adjacent to the LSOV probably due to preferential conduction, intramural VA origins or myocardium in contact with the LCC.
Authors:
Takumi Yamada; H Thomas McElderry; Taro Okada; Yoshimasa Murakami; Harish Doppalapudi; Naoki Yoshida; Yukihiko Yoshida; Yasuya Inden; Toyoaki Murohara; Andrew E Epstein; Vance J Plumb; G Neal Kay
Publication Detail:
Type:  Journal Article     Date:  2009-10-05
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-6     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Body Surface Potential Mapping / methods*
Female
Humans
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Sinus of Valsalva*
Tachycardia, Ventricular / complications*,  diagnosis*
Ventricular Dysfunction, Left / diagnosis*,  etiology*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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