TY - JOUR
T1 - Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle
AU - Ceresnak, Scott R.
AU - Pass, Robert H.
AU - Krumerman, Andrew K.
AU - Kim, Soo G.
AU - Nappo, Lynn
AU - Fisher, John D.
PY - 2012/7
Y1 - 2012/7
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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U2 - 10.1016/j.jelectrocard.2012.03.009
DO - 10.1016/j.jelectrocard.2012.03.009
M3 - Article
C2 - 22554461
AN - SCOPUS:84862864816
SN - 0022-0736
VL - 45
SP - 385
EP - 390
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
IS - 4
ER -