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- Title
Prevalence and electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the septal left ventricular summit.
- Authors
Yamada, Takumi; Litovsky, Silvio; Neal Kay, George
- Abstract
Introduction: The left ventricular summit (LVS) is the highest point on the epicardial surface of the left ventricle. A part of the LVS that is located between the left coronary arteries (lateral‐LVS) is one of the major sites of idiopathic ventricular arrhythmia (VA) origins. Some idiopathic epicardial VAs can be ablated at endocardial sites adjacent to the epicardial area septal to the lateral‐LVS (septal‐LVS). This study examined the prevalence and electrocardiographic and electrophysiological characteristics of septal‐LVS VAs. Methods: We studied consecutive patients with idiopathic VAs originating from the LVS (67 patients) and aortic root (93 patients). Results: Based on the ablation results, among 67 LVS VAs, 54 were classified as lateral and 13 as septal‐LVS VAs. As compared with the lateral‐LVS VAs, the septal‐LVS VAs were characterized by a greater prevalence of left bundle branch block with left inferior‐axis QRS pattern, later precordial transition, lower R‐wave amplitude ratio in leads III to II, lower Q‐wave amplitude ratio in leads aVL to aVR, and later local ventricular activation time relative to the QRS onset during VAs (V‐QRS) in the great cardiac vein. The electrocardiographic and electrophysiological characteristics of the septal‐LVS VAs were similar to those of the aortic root VAs. However, the V‐QRS at the successful ablation site was significantly later during the septal‐LVS VAs than aortic root VAs (p <.0001). The precordial transition was significantly later during the septal‐LVS VAs than aortic root VAs (p <.05). Conclusions: Septal‐LVS VAs are considered a distinct subgroup of idiopathic VAs originating from the left ventricular outflow tract.
- Subjects
UNITED States; LEFT heart ventricle; BUNDLE-branch block; DESCRIPTIVE statistics; ELECTROCARDIOGRAPHY; HEART conduction system; VENTRICULAR arrhythmia; VENTRICULAR septal defects; CATHETER ablation; ELECTROPHYSIOLOGY
- Publication
Journal of Cardiovascular Electrophysiology, 2024, Vol 35, Issue 6, p1174
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.16270