Document Detail


Ubiquitous Myocardial Extensions into the Pulmonary Artery Demonstrated by Integrated Intracardiac Echocardiography and Electroanatomic Mapping: Changing the Paradigm of Idiopathic Right Ventricular Outflow Tract Arrhythmias.
MedLine Citation:
PMID:  24917663     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Idiopathic ventricular arrhythmias of left bundle branch block, inferior axis morphology are usually localized to the right ventricular outflow tract (RVOT), presumably below the pulmonic valve (PV). However, the PV location is usually not confirmed by direct visualization.
METHODS AND RESULTS: -Intracardiac echocardiography (ICE) was used to visualize and tag the PV annulus, which was then integrated with 3-dimensional voltage maps of the RVOT. Distances were measured from the furthest extent of myocardial signal (bipolar voltage ≥ 1.5 mV) to the PV annulus. This was performed in 24 control patients and 24 prospective patients with RVOT arrhythmias. Myocardial signal beyond the pulmonic valve was found in 92% of controls and 88% of RVOT arrhythmia patients (p=1.000). Average myocardial extension was further on the septal side than the free wall side for both control patients (5.6 mm [IQR 3.6 - 7.7] vs 1.7 mm [IQR (-) 0.1 - (+) 4.0], p=0.002) and RVOT arrhythmia patients (5.7 mm [IQR 2.7 - 7.7] vs 1.4 mm [IQR (-) 0.8 - (+) 4.8], p=0.004). Eleven (46%) RVOT arrhythmia foci were localized beyond the valve in the pulmonary artery (median 8.2 mm above PV, IQR 6.6-10.3 mm); these locations were confirmed as supravalvular by direct ICE visualization.
CONCLUSIONS: -Myocardial voltage extension into the pulmonary artery in humans is ubiquitous and can be demonstrated in vivo using 3D-integrated ICE to localize the pulmonic valve. These extensions frequently serve as origins of presumed RVOT arrhythmias; ICE localization of the pulmonic valve allows reclassification of these as pulmonary arterial arrhythmias.
Authors:
Christopher F Liu; Jim W Cheung; George Thomas; James E Ip; Steven M Markowitz; Bruce B Lerman
Related Documents :
12898243 - Mechanisms of death in the early postoperative period following coronary artery bypass ...
14988623 - Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention a...
18806013 - Pulse pressure and risk of adverse outcome in coronary bypass surgery.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-10
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

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


Previous Document:  Early Initiation of Combination Antiretroviral Therapy in HIV-1-Infected Newborn Infants can Achieve...
Next Document:  Prevalence of unknown thyroid disorders in a Sardinian cohort.