Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias.
OBJECTIVE
We sought to clarify the prevalence and characteristics of idiopathic ventricular tachycardia or premature ventricular contraction originating from the mitral annulus (MAVT/PVC).


BACKGROUND
Recent case reports have presented patients with MAVT/PVC.


METHODS
Electrocardiographic (ECG) characteristics and the results of electrophysiologic investigation and radiofrequency catheter ablation (RFCA) were analyzed in 352 patients with symptomatic idiopathic ventricular tachycardia (IVT)/premature ventricular contraction (PVC).


RESULTS
Nineteen cases of IVT/PVC (5%) represented MAVT/PVC. Of these, 11 (58%) originated from the anterolateral portion of the mitral annulus (AL-MAVT/PVC), and 2 (11%) arose from the posterior portion (Pos-MAVT/PVC). The remaining six cases of MAVT/PVC (31%) had posteroseptal origin (PS-MAVT/PVC). In all patients, an S-wave was present in lead V(6). The QRS polarity in inferior leads and leads I and aVL was useful for differentiating AL-MAVT/PVC from Pos-MAVT/PVC or PS-MAVT/PVC. The Pos-MAVT/PVC had an Rs pattern in lead I and an R pattern in lead V(1), whereas PS-MAVT/PVC invariably had an R pattern in lead I and a negative QRS component in lead V(1). The AL-MAVT/PVC and Pos-MAVT/PVC showed a longer QRS duration than the PS-MAVT/PVC (p < 0.001), and all had late-phase "notching" of the QRS complex in inferior leads. In all patients, RFCA eliminated MAVT/PVC, with no recurrences during follow-up for 21 +/- 15 months.


CONCLUSIONS
Mitral annular VT/PVC is a rare but distinct subgroup of IVT/PVC. MAVT/PVC origin could be determined by ECG analysis. The AL and PS sites of the MA were preferential.
Tada
Hiroshi
H
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan. tada.h@cvc.pref.gunma.jp
Ito
Sachiko
S
Naito
Shigeto
S
Kurosaki
Kenji
K
Kubota
Shoichi
S
Sugiyasu
Aiko
A
Tsuchiya
Taketsugu
T
Miyaji
Kohei
K
Yamada
Minoru
M
Kutsumi
Yasunori
Y
Oshima
Shigeru
S
Nogami
Akihiko
A
Taniguchi
Koichi
K
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology* / Q000601:surgery; D015995:Prevalence; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery