Idiopathic left ventricular tachycardia originating from the mitral annulus.
BACKGROUND
Radiofrequency catheter ablation (RFCA) can eliminate most idiopathic repetitive monomorphic ventricular tachycardias (RMVTs) originating from the right and left ventricular outflow tracts (RVOT, LVOT). Here, we describe the electrophysiological (EP) findings of a new variant of RMVT originating from the mitral annulus (MAVT).


RESULTS
MAVT was identified in 35 patients out of 72 consecutive left ventricular RMVTs from May 2000 to June 2004. All patients underwent an EP study and RFCA. The sites of origin of the MAVT were grouped into four groups according to the successful ablation sites around the mitral annulus. Group I included the anterior sites (n = 11), group II the anterolateral sites (n = 9), group III the lateral sites (n = 6), and group IV the posterior sites (n = 9). The MAVTs were a wide QRS tachycardia with a delta wave-like beginning of the QRS complex. The transitional zone of the R wave occurred between V1-V2 in all cases. The 12-lead electrocardiogram (ECG) pattern might reflect the site of the origin of MAVTs around the mitral annulus. We proposed an algorithm for predicting the site of the focus and the tactics needed for successful RFCA of the MAVT.


CONCLUSIONS
We described the EP findings of the new variant of RMVT, MAVT. Most MAVTs could be eliminated by RF applications to the endocardial mitral annulus using our proposed tactics.
Kumagai
Koji
K
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. kkumagai@cardio.med.tohoku.ac.jp
Yamauchi
Yasuteru
Y
Takahashi
Atsushi
A
Yokoyama
Yasuhiro
Y
Sekiguchi
Yukio
Y
Watanabe
Jun
J
Iesaka
Yoshito
Y
Shirato
Kunio
K
Aonuma
Kazutaka
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D017115:Catheter Ablation / Q000379:methods; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology; D014927:Wolff-Parkinson-White Syndrome / Q000209:etiology