BACKGROUND: The coronary cusps have recently become target sites for radiofrequency catheter ablation of both outflow tract ventricular arrhythmias originating near the coronary cusps (CC-VA) and atrial tachyarrhythmias such as focal atrial tachycardia originating near the noncoronary cusp (NCC-AT). However, the relation between local electrograms recorded at each CC during sinus rhythm and their anatomical position as assessed by aortography has not yet been systematically described. METHODS AND RESULTS: In 28 patients undergoing RFCA for CC-VA or NCC-AT, amplitudes of the atrial and ventricular potentials at the CCs were measured during sinus rhythm, and the atrial/ventricular (A/V) potential ratio was computed. Relative positions of the CCs were assessed by aortography in 2 X-ray projections. In the right (RCC) and left coronary cusps (LCC), amplitudes of the ventricular potential were larger than those of the atrial potential, leading to an A/V ratio <1 in all patients (0.08 ± 0.10, 0.32 ± 0.21, respectively). In contrast, in the NCC, the amplitude of the atrial potential was larger than the ventricular potential, leading to a higher A/V ratio relative to the CCs (5.7 ± 2.6, P < 0.0001). Aortography demonstrated the rightward and anterior location of the RCC, the leftward and superior location of the LCC, and the inferior and posterior location of the NCC. CONCLUSIONS: Awareness of the distinctive local electrogram pattern of each CC and their positions on aortography should lead to safer and more effective catheter ablation at the CCs.
BACKGROUND: The coronary cusps have recently become target sites for radiofrequency catheter ablation of both outflow tract ventricular arrhythmias originating near the coronary cusps (CC-VA) and atrial tachyarrhythmias such as focal atrial tachycardia originating near the noncoronary cusp (NCC-AT). However, the relation between local electrograms recorded at each CC during sinus rhythm and their anatomical position as assessed by aortography has not yet been systematically described. METHODS AND RESULTS: In 28 patients undergoing RFCA for CC-VA or NCC-AT, amplitudes of the atrial and ventricular potentials at the CCs were measured during sinus rhythm, and the atrial/ventricular (A/V) potential ratio was computed. Relative positions of the CCs were assessed by aortography in 2 X-ray projections. In the right (RCC) and left coronary cusps (LCC), amplitudes of the ventricular potential were larger than those of the atrial potential, leading to an A/V ratio <1 in all patients (0.08 ± 0.10, 0.32 ± 0.21, respectively). In contrast, in the NCC, the amplitude of the atrial potential was larger than the ventricular potential, leading to a higher A/V ratio relative to the CCs (5.7 ± 2.6, P < 0.0001). Aortography demonstrated the rightward and anterior location of the RCC, the leftward and superior location of the LCC, and the inferior and posterior location of the NCC. CONCLUSIONS: Awareness of the distinctive local electrogram pattern of each CC and their positions on aortography should lead to safer and more effective catheter ablation at the CCs.
Authors: Sixian Weng; Zhengqin Zhai; Min Tang; Bin Zhou; Lei Ding; Fengyuan Yu; Yingjie Qi; Hongda Zhang; Tianjie Feng; Shu Zhang Journal: Front Cardiovasc Med Date: 2021-12-20
Authors: Muhieddine Chokr; Lucas G de Moura; Italo Bruno Dos Santos Sousa; Cristiano Faria Pisani; Carina Abigail Hardy; Sissy Lara de Melo; Arnobio Dias da Ponte Filho; Ieda Prata Costa; Ronaldo Vasconcelos Tavora; Luciana Sacilotto; Tan Chen Wu; Francisco Carlos da Costa Darrieux; Denise Tessariol Hachul; Vera Demarchi Aiello; Mauricio Scanavacca Journal: Arq Bras Cardiol Date: 2021-01 Impact factor: 2.000