Document Detail

Right and left ventricular outflow tract tachycardias: evidence for a common electrophysiologic mechanism.
MedLine Citation:
PMID:  16800855     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: "Idiopathic" ventricular arrhythmias most often arise from the right ventricular outflow tract (RVOT), although arrhythmias from the left ventricular outflow tract (LVOT) are also observed. While previous work has elucidated the mechanism and electropharmacologic profile of RVOT arrhythmias, it is unclear whether those from the LVOT share these properties. The purpose of this study was to characterize the electropharmacologic properties of RVOT and LVOT arrhythmias. METHODS AND RESULTS: One hundred twenty-two consecutive patients (61 male; 50.9 +/- 15.2 years) with outflow tract arrhythmias comprise this series, 100 (82%) with an RVOT origin, and 22 (18%) with an LVOT origin. The index arrhythmia was similar: sustained ventricular tachycardia (VT) (RVOT = 28%, LVOT = 36%), nonsustained VT (RVOT = 40%, LVOT = 23%), and premature ventricular complexes (RVOT = 32%, LVOT = 41%) (P = 0.32). Cardiac magnetic resonance imaging and microvolt T-wave alternans results (normal/indeterminate) were also comparable. In addition, 41% with RVOT foci and 50% with LVOT foci were inducible for sustained VT (P = 0.48), and induction of VT was catecholamine dependent in a majority of patients in both groups (66% and 73%; RVOT and LVOT, respectively; P = 1.0). VT was sensitive to adenosine (88% and 78% in the RVOT and LVOT groups, respectively, P = 0.59) as well as blockade of the slow-inward calcium current (RVOT = 70%, LVOT = 80%; P = 1.00) in both groups. CONCLUSIONS: Electrophysiologic and pharmacologic properties, including sensitivity to adenosine, are similar for RVOT and LVOT arrhythmias. Despite disparate sites of origin, these data suggest a common arrhythmogenic mechanism, consistent with cyclic AMP-mediated triggered activity. Based on these similarities, these arrhythmias should be considered as a single entity, and classified together as "outflow tract arrhythmias."
Sei Iwai; Daniel J Cantillon; Robert J Kim; Steven M Markowitz; Suneet Mittal; Kenneth M Stein; Bindi K Shah; Ravi K Yarlagadda; Jim W Cheung; Vivian R Tan; Bruce B Lerman
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2006-06-27
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-22     Completed Date:  2006-10-17     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1052-8     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, NY 10021, USA.
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MeSH Terms
Action Potentials / drug effects
Adenosine / administration & dosage,  diagnostic use*
Aged, 80 and over
Anti-Arrhythmia Agents / diagnostic use
Evidence-Based Medicine
Heart Conduction System / drug effects,  physiopathology*
Middle Aged
Tachycardia, Ventricular / complications,  physiopathology*
Ventricular Dysfunction, Left / etiology,  physiopathology*
Ventricular Dysfunction, Right / etiology,  physiopathology*
Grant Support
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 58-61-7/Adenosine
Comment In:
J Cardiovasc Electrophysiol. 2006 Oct;17(10):1059-61   [PMID:  16989647 ]

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