TY - JOUR
T1 - Electrocardiographic and Electrophysiologic Characteristics of Idiopathic Ventricular Arrhythmias Originating From the Basal Inferoseptal Left Ventricle
AU - Liang, Jackson J.
AU - Shirai, Yasuhiro
AU - Briceño, David F.
AU - Muser, Daniele
AU - Enriquez, Andres
AU - Lin, Aung
AU - Hyman, Matthew C.
AU - Kumareswaran, Ramanan
AU - Arkles, Jeffrey S.
AU - Santangeli, Pasquale
AU - Schaller, Robert D.
AU - Supple, Gregory E.
AU - Frankel, David S.
AU - Deo, R.
AU - Epstein, Andrew E.
AU - Garcia, Fermin C.
AU - Riley, Michael P.
AU - Nazarian, S.
AU - Lin, D.
AU - Callans, David J.
AU - Marchlinski, Francis E.
AU - Dixit, Sanjay
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/7
Y1 - 2019/7
N2 - Objectives: This study sought to characterize ventricular arrhythmia (VA) ablated from the basal inferoseptal left ventricular endocardium (BIS-LVe) and identify electrocardiographic characteristics to differentiate from inferobasal crux (IBC) VA. Background: The inferior basal septum is an uncommon source of idiopathic VAs, which can arise from its endocardial or epicardial (crux) aspect. Because the latter are often targeted from the coronary venous system or epicardium, distinguishing between the 2 is important for successful ablation. Methods: Consecutive patients undergoing ablation of idiopathic VA from the BIS-LVe or IBC from 2009 to 2018 were identified and clinical characteristics and electrocardiographs of VA were compared. Results: Of 931 patients undergoing idiopathic VA ablation, Virginia was eliminated from the BIS-LVe in 19 patients (2%) (17 male, age 63.7 ± 9.2 years, LV ejection fraction: 45.0 ± 9.3%). QRS complexes typically manifested right bundle branch block morphology with “reverse V2 pattern break” and left superior axis (more negative in lead III than II). VA elimination was achieved after median of 2 lesions (interquartile range [IQR]: 1–6; range 1 to 20) (radiofrequency ablation time: 123 s [IQR: 75–311]). Compared with 7 patients with IBC VA (3 male, age 51.9 ± 20.1 years, LV ejection fraction: 51.4 ± 17.7%), BIS-LVe VA less frequently had initial negative forces (QS pattern) in leads II, III, and/or aVF (p < 0.001), R-S ratio <1 in lead V1 (p = 0.005), and notching in lead II (p = 0.006) were narrower (QRS duration: 178.2 ± 22.4 vs. 221.1 ± 41.9 ms; p = 0.04) and more frequently had maximum deflection index of <0.55 (p < 0.001). Conclusions: The BIS-LVe region is an uncommon source of idiopathic VA. Distinguishing these from IBC VA is important for procedural planning and ablation success.
AB - Objectives: This study sought to characterize ventricular arrhythmia (VA) ablated from the basal inferoseptal left ventricular endocardium (BIS-LVe) and identify electrocardiographic characteristics to differentiate from inferobasal crux (IBC) VA. Background: The inferior basal septum is an uncommon source of idiopathic VAs, which can arise from its endocardial or epicardial (crux) aspect. Because the latter are often targeted from the coronary venous system or epicardium, distinguishing between the 2 is important for successful ablation. Methods: Consecutive patients undergoing ablation of idiopathic VA from the BIS-LVe or IBC from 2009 to 2018 were identified and clinical characteristics and electrocardiographs of VA were compared. Results: Of 931 patients undergoing idiopathic VA ablation, Virginia was eliminated from the BIS-LVe in 19 patients (2%) (17 male, age 63.7 ± 9.2 years, LV ejection fraction: 45.0 ± 9.3%). QRS complexes typically manifested right bundle branch block morphology with “reverse V2 pattern break” and left superior axis (more negative in lead III than II). VA elimination was achieved after median of 2 lesions (interquartile range [IQR]: 1–6; range 1 to 20) (radiofrequency ablation time: 123 s [IQR: 75–311]). Compared with 7 patients with IBC VA (3 male, age 51.9 ± 20.1 years, LV ejection fraction: 51.4 ± 17.7%), BIS-LVe VA less frequently had initial negative forces (QS pattern) in leads II, III, and/or aVF (p < 0.001), R-S ratio <1 in lead V1 (p = 0.005), and notching in lead II (p = 0.006) were narrower (QRS duration: 178.2 ± 22.4 vs. 221.1 ± 41.9 ms; p = 0.04) and more frequently had maximum deflection index of <0.55 (p < 0.001). Conclusions: The BIS-LVe region is an uncommon source of idiopathic VA. Distinguishing these from IBC VA is important for procedural planning and ablation success.
KW - catheter ablation
KW - epicardial
KW - left ventricular ostium
KW - premature ventricular complexes
KW - ventricular arrhythmia
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U2 - 10.1016/j.jacep.2019.04.002
DO - 10.1016/j.jacep.2019.04.002
M3 - Article
C2 - 31320012
AN - SCOPUS:85068251986
SN - 2405-500X
VL - 5
SP - 833
EP - 842
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 7
ER -