title: Electrocardiographic characteristics of ventricular arrhythmias originating from the junction of the left and right coronary sinuses of Valsalva in the aorta: the activation pattern as a rationale for the electrocardiographic characteristics.
abstract: BACKGROUND
  Ventricular arrhythmias (VAs) may arise from the aortic sinuses and have electrocardiographic and electrophysiological characteristics that suggest a left (LCC) or right coronary cusp (RCC) origin. However, VAs that arise near the junction of those two cusps (L-RCC) may have unusual features.
  
  
  OBJECTIVE
  The purpose of this study was to examine the electrocardiographic and electrophysiological characteristics of VAs arising from the L-RCC.
  
  
  METHODS
  We studied 155 patients with idiopathic VAs with either left or right bundle branch block and an inferior QRS axis morphology and five control subjects undergoing a pacing study.
  
  
  RESULTS
  For 146 of the 155 patients, the origin determined by the successful ablation site was at the L-RCC in five, LCC in 13, RCC in six, non-coronary cusp in two, right ventricular outflow tract in 108, left ventricular outflow tract in five, left ventricular epicardium in four, and pulmonary artery in three. A qrS pattern in leads V1-V3 was observed only in the VAs with an L-RCC origin. The propagation map revealed that the direction of the propagating wave front from the L-RCC origin produced a vector compatible with a q wave and that the anterior activation to the right ventricular outflow tract via the LCC or RCC formed the r wave. Pacing performed at multiple sites in the aortic root in the control subjects demonstrated that only pacing from the L-RCC could reproduce a qrS pattern in leads V1-V3.
  
  
  CONCLUSIONS
  This study revealed that a qrS pattern in leads V1-V3 suggests a site of origin at the L-RCC.
authors.affiliation: Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Taro
authors.initials: T
authors.lastname: Okada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Muto
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Hugh T
authors.initials: HT
authors.lastname: McElderry
authors.forename: G Neal
authors.initials: GN
authors.lastname: Kay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000503:physiopathology*; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D002037:Bundle-Branch Block / Q000503:physiopathology*; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012850:Sinus of Valsalva / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery