Electrocardiographic characteristics of the variants of idiopathic left ventricular outflow tract ventricular tachyarrhythmias.
BACKGROUND
Despite similar QRS morphology, idiopathic repetitive monomorphic ventricular tachyarrhythmias (VTs) of left ventricular outflow tract (LVOT) are known to have the variants of different adjacent origins, including the aorto-mitral continuity (AMC), anterior site around the mitral annulus (MA), aortic sinus cusps (ASC), and epicardium. However, the electrocardiographic characteristics of those variants previously have not been evaluated fully.


RESULTS
Based on the mapping site and successful ablation in 45 consecutive patients with LVOT-VTs, we classified them into VTs of AMC (n = 3), MA (n = 8), ASC (n = 32), and epicardial (n = 2) origins. In all patients, we performed activation mapping and an electrocardiographic analysis. All AMC-VTs patients had monophasic R waves in almost all the precordial leads, while those with anterior MA-VTs had an Rs pattern in some precordial leads except for lead V6, and those with ASC-VTs had a variable transitional zone in leads V1-4. There was no S wave in lead V6 in any group except for one patient with anterior MA-VTs. The intrinsicoid deflection time in the AMC-VTs patients and anterior MA-VTs patients was significantly greater than in those with ASC-VTs (P < 0.05). There was no significant difference in the R-wave amplitude in the inferior leads among the groups. Successful radiofrequency catheter ablation (RFCA) was achieved in all patients except for in those with epicardial origin VT.


CONCLUSIONS
Despite many morphological similarities, the LVOT-VTs originating from the AMC, anterior MA and ASC could be identified by our proposed electrocardiographic characteristics in order to safely perform RFCA.
Kumagai
Koji
K
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. kk4917@mvb.biglobe.ne.jp
Fukuda
Koji
K
Wakayama
Yuji
Y
Sugai
Yoshinao
Y
Hirose
Masanori
M
Yamaguchi
Nobuhiro
N
Takase
Kei
K
Yamauchi
Yasuteru
Y
Takahashi
Atsushi
A
Aonuma
Kazutaka
K
Shimokawa
Hiroaki
H
D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*