Elsevier

Heart Rhythm

Volume 4, Issue 1, January 2007, Pages 7-16
Heart Rhythm

Original-clinical
Idiopathic ventricular arrhythmias originating from the tricuspid annulus: Prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation

https://doi.org/10.1016/j.hrthm.2006.09.025Get rights and content

Background

Idiopathic ventricular tachycardias (VTs) and premature ventricular contractions (PVCs) arising from the tricuspid annulus have been reported.

Objective

The purpose of this study was to clarify the prevalence and characteristics of VT/PVCs originating from the tricuspid annulus.

Methods

The ECG characteristics and results of radiofrequency (RF) catheter ablation were analyzed in 454 patients with idiopathic VT/PVCs.

Results

Thirty-eight (8%) patients had VT/PVCs arising from the tricuspid annulus: 28 VT/PVCs (74%) originated from the septal portion of the tricuspid annulus and the remaining 10 (26%) from the free wall of the tricuspid annulus. QRS duration and Q-wave amplitude in each of leads V1–V3 were greater in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (all P <.01). “Notching” of the QRS complex was observed more often in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (P <.01). A Q wave in lead V1 was observed more often in VT/PVCs arising from the septum of the tricuspid annulus than those from the free wall of the tricuspid annulus (P <.005). R-wave transition occurred beyond lead V3 more often in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (P <.005). RF catheter ablation eliminated 90% of the VT/PVCs arising from the free wall of the tricuspid annulus but only 57% of the VT/PVCs arising from septum of the tricuspid annulus.

Conclusion

Idiopathic VT/PVCs arising from tricuspid annulus are not rare, and the detailed origin can be determined by ECG analysis. The preferential site of origin was the septum but also could be the free wall of the tricuspid annulus.

Introduction

The majority of idiopathic ventricular arrhythmias, including ventricular tachycardias (VTs) and premature ventricular contractions (PVCs), have a right ventricular outflow tract or left ventricular inferoseptal origin,1, 2, 3, 4, 5 but some originate from the endocardium of the left ventricular outflow tract,5, 6 left ventricular epicardial sites,5, 7, 8 or mitral annulus.9 A small number of cases of idiopathic ventricular arrhythmias (VT/PVCs) have been reported to originate from the subtricuspid septum, near the His bundle,4, 5, 10 or the right ventricular inflow tract,3 indicating the possibility that idiopathic VT/PVCs originate from the tricuspid annulus. However, little is known about the prevalence, ECG characteristics, preferential sites of tachycardia origin around the tricuspid annulus, or efficacy of radiofrequency (RF) catheter ablation of idiopathic VT/PVCs of this kind. This study was undertaken to clarify these points.

Section snippets

Study population

The study consisted of 454 consecutive patients (222 women and 232 men; age 53 ± 17 years [mean ± SD]) with symptomatic, idiopathic VT/PVCs who underwent RF catheter ablation at the Gunma Prefectural Cardiovascular Center between January 2000 and September 2005. Monomorphic VT (defined as ≥3 consecutive PVCs) was present in 151 patients, and 55 VTs (36%) were sustained and lasted for >30 seconds. The remaining 303 patients had monomorphic PVCs. All patients had a normal ECG recorded during

Prevalence and clinical characteristics of VT/PVCs arising from the tricuspid annulus

In the 454 patients treated by RF catheter ablation, 357 idiopathic VT/PVCs (79%) were ablated successfully, but the remaining 97 idiopathic VT/PVCs (21%) failed to be ablated (Table 1). Among all patients, 38 (8%) VT/PVCs exhibited earliest ventricular activation when the VT/PVCs were recorded from the tricuspid annulus and/or a perfect pace map was obtained at that site (14 women and 24 men; mean age 61 ± 14 years; Table 1, Table 2). Before the ablation procedure, 13 patients had monomorphic

Major findings

This study demonstrated for the first time that 8% of idiopathic VT/PVCs had an origin at the tricuspid annulus, and that the septal portion of the annulus, especially the anteroseptum, was the preferential site of origin, but the site of origin also could be located at the free-wall portion of the annulus. ECG findings, such as QRS duration, presence of QRS “notching,” Q-wave amplitude in leads V1–V3, R-wave transition in the precordial leads, QS pattern in lead V1, and polarity of the QRS

References (24)

  • H. Yamabe et al.

    Electrophysiologic characteristics of verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus

    Am J Cardiol

    (2005)
  • E. Daoud et al.

    Catheter ablation of ventricular tachycardia

    Curr Opin Cardiol

    (1995)
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