Idiopathic ventricular arrhythmias originating from the aortic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequency catheter ablation.
OBJECTIVE
This study investigated the prevalence and electrocardiographic and electrophysiologic characteristics of aortic root ventricular arrhythmias (VAs).


BACKGROUND
Idiopathic VAs originating from the ostium of the left ventricle may be ablated at the base of the aortic cusps.


METHODS
We studied 265 patients with idiopathic VAs with an inferior QRS-axis morphology.


RESULTS
The successful ablation site was within (or below) the aortic cusps in 44 patients (16.6%). The site of the origin was the left coronary cusp (LCC) in 24 (54.5%), the right coronary cusp (RCC) in 14 (31.8%), the noncoronary cusp (NCC) in 1 (2.3%), and at the junction between the LCC and RCC (L-RCC) in 5 (11.4%) cases. The maximum amplitude of the R-wave in the inferior leads was significantly greater with an LCC than with an RCC origin (p < 0.05). The ratio of the R-wave amplitude in leads II and III was significantly greater with an LCC than with an RCC origin (p < 0.01) and was significantly smaller in the NCC than in the other sites (p < 0.0001). The ventricular deflection in the His bundle electrogram was significantly later relative to the surface QRS with an LCC or L-RCC origin than with an RCC or NCC origin (p < 0.0001). The ratio of the atrial-to-ventricular deflection amplitude was significantly greater in the NCC than in the other sites (p < 0.0001). No other factors predicted the site of origin.


CONCLUSIONS
Idiopathic VAs are more common in the LCC than in the RCC and rarely arise from the NCC. The electrocardiogram is useful for differentiating the site of origin.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
McElderry
H Thomas
HT
Doppalapudi
Harish
H
Murakami
Yoshimasa
Y
Yoshida
Yukihiko
Y
Yoshida
Naoki
N
Okada
Taro
T
Tsuboi
Naoya
N
Inden
Yasuya
Y
Murohara
Toyoaki
T
Epstein
Andrew E
AE
Plumb
Vance J
VJ
Singh
Satinder P
SP
Kay
G Neal
GN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001018:Aortic Diseases / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D001145:Arrhythmias, Cardiac / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged