Document Detail

Mechanisms and utility of discrete great arterial potentials in the ablation of outflow tract ventricular arrhythmias.
MedLine Citation:
PMID:  19808391     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Outflow tract ventricular tachycardia originating above the semilunar valves has been reported in a small number of studies. Discrete potentials in the great arteries (above the semilunar valves) have been rarely described in patients undergoing electrophysiology evaluation and radiofrequency ablation for ventricular arrhythmias. The mechanisms of these discrete potentials in the great arteries and the utility of such potentials in guiding radiofrequency ablation are unknown. METHODS AND RESULTS: Twelve patients with outflow tract ventricular arrhythmia originating above the semilunar valves with discrete arterial potentials were studied. The clinical characteristics, properties of the arterial potentials, electrophysiological evaluation and ablation, and short- and long-term outcomes were reviewed. Of the twelve patients, 8 (67%) were women. The patients' average age was 41+/-14 years. The average ejection fraction was 0.52+/-0.16 (range: 0.16 to 0.75). Contact mapping in the great artery demonstrated discrete near-field electrograms that were separate from far-field ventricular electrograms in all patients (8 above the pulmonary valve and in 4 the aortic valve). One or more of the following electrophysiological characteristics, supportive of an arrhythmogenic substrate, were observed in 10 of 12 patients: (1) A fixed or reproducibly variable pattern of discrete potential-ventricular arrhythmia relationship was present at baseline or during pacing; (2) the discrete potential-ventricular electrogram relationship during sinus rhythm was the reverse of that during the ventricular arrhythmia; (3) during sustained ventricular tachycardia, spontaneous variation of the ventricular (V-V) cycle length was preceded by a similar variation of arterial spike potential-spike potential cycle length; and (4) ablation guided by the discrete arterial potential successfully eliminated the clinical arrhythmia. Ablation was successful in these patients. In the remaining 2 patients, the potentials were believed to be bystanders. Over 10+/-4 months (range: 5 to 32 months) of follow-up, there have been no recurrences of the premature ventricular complex or ventricular arrhythmia. CONCLUSIONS: Discrete potentials are present in the great arteries of a select group of patients with outflow tract ventricular tachycardia originating above the semilunar valves. When an arrhythmogenic relationship can be demonstrated, discrete potentials are useful in guiding ablation within the great vessels, despite significant anatomic complexity.
Komandoor S Srivathsan; T Jared Bunch; Samuel J Asirvatham; William D Edwards; Paul A Friedman; Thomas M Munger; Stephen C Hammill; Yong-Mei Cha; Peter A Brady; Arshad Jahangir; David J Bradley; Robert F Rea; Douglas L Packer; Win-Kuang Shen
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  1     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-8     Citation Subset:  IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz, USA.
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MeSH Terms
Action Potentials
Aorta / physiopathology,  surgery*
Cardiac Pacing, Artificial
Catheter Ablation*
Electrophysiologic Techniques, Cardiac
Middle Aged
Predictive Value of Tests
Pulmonary Artery / physiopathology,  surgery*
Reproducibility of Results
Retrospective Studies
Stroke Volume
Tachycardia, Ventricular / physiopathology,  surgery*
Time Factors
Treatment Outcome
Ventricular Function, Left

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

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