Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure.
BACKGROUND
Ventricular arrhythmias are known to originate from the aortic sinus of Valsalva.


OBJECTIVE
The purpose of this study was to identify the characteristics associated with ventricular arrhythmias originating from the right coronary cusp-left coronary cusp (RCC-LCC) commissure.


METHODS
Thirty-seven consecutive patients with ventricular arrhythmias originating from the aortic cusp region were studied. Intracardiac echocardiography and electroanatomic mapping were used to define coronary cusp anatomy and catheter position. Ventricular arrhythmias from the RCC-LCC commissure were compared with ventricular arrhythmias originating from other sites in the aortic cusp region.


RESULTS
Nineteen (51%) ventricular arrhythmias had an anatomic origin at the RCC-LCC commissure. Eighteen ventricular arrhythmias originated from other aortic cusp sites (4 right cusp, 7 left cusp, 3 left ventricular endocardium, 4 left ventricular epicardium anterior to aortic valve). A QS morphology in lead V(1) with notching on the downward deflection was present in 15 of 19 ventricular arrhythmias originating from the RCC-LCC commissure compared to 2 of 18 ventricular arrhythmias from other aortic cusp sites (P <.01). At the site of earliest activation, 13 of 19 patients with RCC-LCC ventricular arrhythmias had late potentials in sinus rhythm compared to 1 of 18 ventricular arrhythmias from other aortic cusp sites (P <.01). The site of successful ablation was confirmed to be above the aortic valve plane in 15 (79%) of 19 patients with RCC-LCC ventricular arrhythmias.


CONCLUSIONS
RCC-LCC aortic cusp ventricular arrhythmias are common and have a QS morphology in lead V(1) with notching on the downward deflection with precordial transition at lead V(3). In the majority of cases, the site of successful ablation has late potentials in sinus rhythm.
Bala
Rupa
R
Electrophysiology Section, Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Garcia
Fermin C
FC
Hutchinson
Mathew D
MD
Gerstenfeld
Edward P
EP
Dhruvakumar
Sandhya
S
Dixit
Sanjay
S
Cooper
Joshua M
JM
Lin
David
D
Harding
John
J
Riley
Michael P
MP
Zado
Erica
E
Callans
David J
DJ
Marchlinski
Francis E
FE
D000328:Adult; D000368:Aged; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology*; D018879:Ventricular Premature Complexes / Q000209:etiology / Q000503:physiopathology*