Feifan Ouyang1, Shibu Mathew2, Shulin Wu2, Masashi Kamioka2, Andreas Metzner2, Yumei Xue2, Weizhu Ju2, Bing Yang2, Xianzhang Zhan2, Andreas Rillig2, Tina Lin2, Peter Rausch2, Sebastian Deiß2, Christine Lemes2, Tobias Tönnis2, Erik Wissner2, Roland Richard Tilz2, Karl-Heinz Kuck2, Minglong Chen2. 1. From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.). ouyangfeifan@gmail.com. 2. From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
Abstract
BACKGROUND: Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach. METHODS AND RESULTS: This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. Radiofrequency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-wave amplitude ratio >1.4 in 7, lead III/II R-wave amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months. CONCLUSIONS: The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofrequency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
BACKGROUND:Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach. METHODS AND RESULTS: This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. Radiofrequency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-wave amplitude ratio >1.4 in 7, lead III/II R-wave amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months. CONCLUSIONS: The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofrequency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
Authors: Masashi Kamioka; Shibu Mathew; Tina Lin; Andreas Metzner; Andreas Rillig; Sebastian Deiss; Peter Rausch; Christine Lemes; Hisaki Makimoto; Hesheng Hu; Dongpo Liang; Erik Wissner; Roland Richard Tilz; Karl-Heinz Kuck; Feifan Ouyang Journal: Clin Res Cardiol Date: 2015-01-30 Impact factor: 5.460
Authors: Jan van den Bruck; Jakob Lüker; Arian Sultan; Karlo Filipovic; Cornelia Scheurlen; Judith Froch-Cordis; Daniel Steven Journal: Herzschrittmacherther Elektrophysiol Date: 2022-05-12
Authors: Apoor Patel; Michelle Nsahlai; Thomas Flautt; Akanibo Da-Warikobo; Adi Lador; Carlos Tapias; Diego Rodríguez; Luis Carlos Sáenz; Paul A Schurmann; Amish Dave; Miguel Valderrábano Journal: Circ Arrhythm Electrophysiol Date: 2022-08-02