Original-clinicalIdiopathic ventricular arrhythmias originating from the tricuspid annulus: Prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation
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.
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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)
- et al.
Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin
J Am Coll Cardiol
(1994) The right ventricular tachycardias
J Electrocardiol
(2000)- et al.
Repetitive monomorphic tachycardia from the left ventricular outflow tract: electrocardiographic patterns consistent with a left ventricular site of origin
J Am Coll Cardiol
(1997) - et al.
Ventricular tachycardias arising from the aortic sinus of Valsalva: an under-recognized variant of left outflow tract ventricular tachycardia
J Am Coll Cardiol
(2001) - et al.
Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation
J Am Coll Cardiol
(2002) - et al.
Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias
J Am Coll Cardiol
(2005) - et al.
Echocardiographic findings in patients meeting task force criteria for arrhythmogenic right ventricular dysplasia: new insights from the multidisciplinary study of right ventricular dysplasia
J Am Coll Cardiol
(2005) - et al.
Arrhythmogenic right ventricular dysplasia/cardiomyopathy: screening, diagnosis, and treatment
Heart Rhythm
(2006) - et al.
Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways
J Am Coll Cardiol
(1996) - et al.
Clinical profile of concealed form of arrhythmogenic right ventricular cardiomyopathy presenting with apparently idiopathic ventricular arrhythmias
Int J Cardiol
(1992)
Electrophysiologic characteristics of verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus
Am J Cardiol
Catheter ablation of ventricular tachycardia
Curr Opin Cardiol
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2020, Heart RhythmCitation Excerpt :Changes in QRS duration, IDT, and precordial R-wave transition from the anterior-lateral FW to the MB and then to the septal wall are consistent with the transformation from the FW to a more septal location. These observations are consistent with previous descriptions.3–5 It is noteworthy that the notch on the descending limb of lead II, III, or aVF could be seen in 83.3% of patients with MB-VAs.