Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle

Scott R. Ceresnak, Robert H. Pass, Andrew K. Krumerman, Soo G. Kim, Lynn Nappo, John Devens Fisher

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Ventricular tachycardia (VT) arising from the right ventricular inflow (RVI) region is uncommon. There is minimal literature on the clinical and electrocardiographic characteristics of RVI VT. Methods: A retrospective analysis of patients with RVI VT who underwent electrophysiology study between 2006 and 2011 was performed. Patients with structural heart disease (including arrhythmogenic right ventricular dysplasia) were excluded. Results: Seventy patients underwent an electrophysiology study for VT arising from the right ventricle during the study period. Nine patients (13%) met the inclusion criteria for RVI VT and were the subject of this analysis. The median age was 46 years (range, 14-71), and VT cycle length was 295 milliseconds (range, 279-400 milliseconds). All VTs had an left bundle-branch block morphology. An inferiorly directed QRS axis was noted in 7 (78%) of 9 patients and a left superior axis in 2 (22%) of 9 patients. A QS or rS pattern was noted in all patients in aVR and V 1. A transition from S to R wave occurred in V 3 to V 5 in all patients, with 78% of the patients transitioning in V 4 or V 5. Ablation was attempted in 8 (89%) of 9 patients and was successful in 6 (67%) of 9 patients. Ablation was limited in all unsuccessful patients due to the proximity to the His and risk of complete heart block. Conclusions: Electrocardiographic findings of a left bundle-branch block with a normal QRS axis, QS or rS patterns in aVR and V 1, and late S to R transition (V 4/V 5) are commonly found in RVI VT. Because of the proximity to the His, ablation of RVI VT may be more challenging than that of right ventricular outflow tract VT.

Original languageEnglish (US)
Pages (from-to)385-390
Number of pages6
JournalJournal of Electrocardiology
Volume45
Issue number4
DOIs
StatePublished - Jul 2012

Fingerprint

Ventricular Tachycardia
Heart Ventricles
Bundle-Branch Block
Electrophysiology
Arrhythmogenic Right Ventricular Dysplasia
Heart Block
Patient Rights
Heart Diseases

Keywords

  • Ablation for ventricular tachycardia
  • Electrocardiography
  • Electrophysiology
  • Right ventricular inflow
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle. / Ceresnak, Scott R.; Pass, Robert H.; Krumerman, Andrew K.; Kim, Soo G.; Nappo, Lynn; Fisher, John Devens.

In: Journal of Electrocardiology, Vol. 45, No. 4, 07.2012, p. 385-390.

Research output: Contribution to journalArticle

Ceresnak, Scott R. ; Pass, Robert H. ; Krumerman, Andrew K. ; Kim, Soo G. ; Nappo, Lynn ; Fisher, John Devens. / Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle. In: Journal of Electrocardiology. 2012 ; Vol. 45, No. 4. pp. 385-390.
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abstract = "Introduction: Ventricular tachycardia (VT) arising from the right ventricular inflow (RVI) region is uncommon. There is minimal literature on the clinical and electrocardiographic characteristics of RVI VT. Methods: A retrospective analysis of patients with RVI VT who underwent electrophysiology study between 2006 and 2011 was performed. Patients with structural heart disease (including arrhythmogenic right ventricular dysplasia) were excluded. Results: Seventy patients underwent an electrophysiology study for VT arising from the right ventricle during the study period. Nine patients (13{\%}) met the inclusion criteria for RVI VT and were the subject of this analysis. The median age was 46 years (range, 14-71), and VT cycle length was 295 milliseconds (range, 279-400 milliseconds). All VTs had an left bundle-branch block morphology. An inferiorly directed QRS axis was noted in 7 (78{\%}) of 9 patients and a left superior axis in 2 (22{\%}) of 9 patients. A QS or rS pattern was noted in all patients in aVR and V 1. A transition from S to R wave occurred in V 3 to V 5 in all patients, with 78{\%} of the patients transitioning in V 4 or V 5. Ablation was attempted in 8 (89{\%}) of 9 patients and was successful in 6 (67{\%}) of 9 patients. Ablation was limited in all unsuccessful patients due to the proximity to the His and risk of complete heart block. Conclusions: Electrocardiographic findings of a left bundle-branch block with a normal QRS axis, QS or rS patterns in aVR and V 1, and late S to R transition (V 4/V 5) are commonly found in RVI VT. Because of the proximity to the His, ablation of RVI VT may be more challenging than that of right ventricular outflow tract VT.",
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AU - Ceresnak, Scott R.

AU - Pass, Robert H.

AU - Krumerman, Andrew K.

AU - Kim, Soo G.

AU - Nappo, Lynn

AU - Fisher, John Devens

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N2 - Introduction: Ventricular tachycardia (VT) arising from the right ventricular inflow (RVI) region is uncommon. There is minimal literature on the clinical and electrocardiographic characteristics of RVI VT. Methods: A retrospective analysis of patients with RVI VT who underwent electrophysiology study between 2006 and 2011 was performed. Patients with structural heart disease (including arrhythmogenic right ventricular dysplasia) were excluded. Results: Seventy patients underwent an electrophysiology study for VT arising from the right ventricle during the study period. Nine patients (13%) met the inclusion criteria for RVI VT and were the subject of this analysis. The median age was 46 years (range, 14-71), and VT cycle length was 295 milliseconds (range, 279-400 milliseconds). All VTs had an left bundle-branch block morphology. An inferiorly directed QRS axis was noted in 7 (78%) of 9 patients and a left superior axis in 2 (22%) of 9 patients. A QS or rS pattern was noted in all patients in aVR and V 1. A transition from S to R wave occurred in V 3 to V 5 in all patients, with 78% of the patients transitioning in V 4 or V 5. Ablation was attempted in 8 (89%) of 9 patients and was successful in 6 (67%) of 9 patients. Ablation was limited in all unsuccessful patients due to the proximity to the His and risk of complete heart block. Conclusions: Electrocardiographic findings of a left bundle-branch block with a normal QRS axis, QS or rS patterns in aVR and V 1, and late S to R transition (V 4/V 5) are commonly found in RVI VT. Because of the proximity to the His, ablation of RVI VT may be more challenging than that of right ventricular outflow tract VT.

AB - Introduction: Ventricular tachycardia (VT) arising from the right ventricular inflow (RVI) region is uncommon. There is minimal literature on the clinical and electrocardiographic characteristics of RVI VT. Methods: A retrospective analysis of patients with RVI VT who underwent electrophysiology study between 2006 and 2011 was performed. Patients with structural heart disease (including arrhythmogenic right ventricular dysplasia) were excluded. Results: Seventy patients underwent an electrophysiology study for VT arising from the right ventricle during the study period. Nine patients (13%) met the inclusion criteria for RVI VT and were the subject of this analysis. The median age was 46 years (range, 14-71), and VT cycle length was 295 milliseconds (range, 279-400 milliseconds). All VTs had an left bundle-branch block morphology. An inferiorly directed QRS axis was noted in 7 (78%) of 9 patients and a left superior axis in 2 (22%) of 9 patients. A QS or rS pattern was noted in all patients in aVR and V 1. A transition from S to R wave occurred in V 3 to V 5 in all patients, with 78% of the patients transitioning in V 4 or V 5. Ablation was attempted in 8 (89%) of 9 patients and was successful in 6 (67%) of 9 patients. Ablation was limited in all unsuccessful patients due to the proximity to the His and risk of complete heart block. Conclusions: Electrocardiographic findings of a left bundle-branch block with a normal QRS axis, QS or rS patterns in aVR and V 1, and late S to R transition (V 4/V 5) are commonly found in RVI VT. Because of the proximity to the His, ablation of RVI VT may be more challenging than that of right ventricular outflow tract VT.

KW - Ablation for ventricular tachycardia

KW - Electrocardiography

KW - Electrophysiology

KW - Right ventricular inflow

KW - Ventricular tachycardia

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