Chin-Yu Lin1, Fa-Po Chung1, Yenn-Jiang Lin1, Eric Chong2, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Ta-Chuan Tuan1, Tze-Fan Chao1, Jo-Nan Liao1, Yao-Ting Chang1, Yun-Yu Chen3, Chun-Ku Chen4, Chuen-Wang Chiou1, Shih-Ann Chen5, Hsuan-Ming Tsao6. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. 2. Division of Cardiology, Department of Medicine, Alexandra Hospital, Jurong Health, Singapore. 3. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. 4. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: epsachen@ms41.hinet.net. 6. Division of Cardiology, National Yang-Ming University Hospital, I-Lan, Taiwan. Electronic address: hmtsao.pohai@msa.hinet.net.
Abstract
BACKGROUND: Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge. OBJECTIVES: The objectives of this study were to investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and to develop an algorithm for predicting the successful ablation site. METHODS: We recruited 66 patients (mean age, 47 ± 15 years; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and the LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n = 20; group 2: subvalvular region, n = 15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n = 16; group 4: epicardium requiring pericardial access, n = 15). The QRS morphological characteristics of VAs were compared between the 4 groups. RESULTS: Electrocardiographic analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cutoff values of ≤1.415, 1.416-1.535, 1.536-1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated with the distance between the successful ablation site and the tip of the LV summit. A distance of >18.9 mm and an LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight patients (12.1%) developed VA recurrence during a mean follow-up of 15.9 months (interquartile range 9.2-24.2 months). CONCLUSION: The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and the LV summit.
BACKGROUND: Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge. OBJECTIVES: The objectives of this study were to investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and to develop an algorithm for predicting the successful ablation site. METHODS: We recruited 66 patients (mean age, 47 ± 15 years; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and the LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n = 20; group 2: subvalvular region, n = 15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n = 16; group 4: epicardium requiring pericardial access, n = 15). The QRS morphological characteristics of VAs were compared between the 4 groups. RESULTS: Electrocardiographic analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cutoff values of ≤1.415, 1.416-1.535, 1.536-1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated with the distance between the successful ablation site and the tip of the LV summit. A distance of >18.9 mm and an LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight patients (12.1%) developed VA recurrence during a mean follow-up of 15.9 months (interquartile range 9.2-24.2 months). CONCLUSION: The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and the LV summit.