title: Simultaneous mapping in the left sinus of valsalva and coronary venous system predicts successful catheter ablation from the left sinus of valsalva.
abstract: Idiopathic ventricular tachycardia originating from the left epicardium (Epi-VT) can be ablated from the left sinus of Valsalva (LSV) in selected patients. We hypothesized that the analysis of electrograms at the LSV and transitional zone from the great cardiac vein to the anterior interventricular vein (GCV-AIV) could predict the efficacy of radiofrequency catheter ablation (RFCA) from the LSV. Simultaneous mapping in the LSV and coronary venous system was performed in 25 patients (12 VTs and 13 premature ventricular contractions). The earliest ventricular activation (VA) during the arrhythmias was found at the LSV or GCV-AIV in all patients. RF applications from the LSV were successful in 17 patients success group (S-Gr) and failed in 8 failure group (F-Gr). The earliness of the VA recorded in the LSV (VA[LSV]) and in GCV-AIV (VA[GCV-AIV]) was compared between the two groups. (1) The VA[LSV] preceded the QRS onset by 28 +/- 11 ms in S-Gr and 14 +/- 10 ms in F-Gr (P < 0.01). (2) In S-Gr, the VA[GCV-AIV] was earlier than the VA[LSV] in 5 five patients (35%). However, in F-Gr, the VA[GCV-AIV] was earlier than the VA[LSV] in all patients. (3) In patients in whom the earliest VA was found at the LSV or GCV-AIV, a VA [GCV-AIV] preceding the VA[LSV] by less than 10 ms identified successful RFCA from the LSV with a sensitivity of 88 %, specificity of 100%, and high predictive value. With a detailed analysis of the electrograms recorded from the GCV-AIV and LSV, it was possible to identify the successful catheter ablation of Epi-VT from the LSV.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.forename: Marehiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Goro
authors.initials: G
authors.lastname: Shinbo
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
mesh_terms: D017115:Catheter Ablation / Q000379:methods; D003331:Coronary Vessels / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012850:Sinus of Valsalva / Q000033:anatomy & histology*; D017180:Tachycardia, Ventricular / Q000601:surgery*; D013997:Time Factors; D018879:Ventricular Premature Complexes / Q000601:surgery*