Focal ventricular arrhythmias originating from the left ventricle adjacent to the membranous septum.
OBJECTIVE
We report the features of focal ventricular arrhythmias (VAs) arising from the left ventricle (LV) adjacent to the membranous septum.


RESULTS
We studied eight patients (five men, 65 ± 10 years) with (n = 2) or without structural heart disease (n = 6) who had ventricular tachycardia (n = 4) or premature ventricular contractions (n = 4) originating from the LV septum underneath the aorta. Ventricular arrhythmias exhibited a focal activation pattern, left (n = 4) or right bundle branch block (n = 4), respectively, left superior (n = 4) or inferior axis QRS morphology (n = 4), negative QRS polarity in lead III and early or no precordial transition in all. During all of these VAs, far-field electrograms in the His bundle (HB) region preceded the QRS onset. In all patients, ventricular pre-potentials were recorded during VAs while late potentials were recorded in sinus rhythm at the border of a localized low-voltage area underneath the aorta. Radiofrequency catheter ablation at the presumed sites of origin successfully eliminated VAs in five patients and was abandoned in the remaining three because the HB electrogram was recorded at that site.


CONCLUSIONS
Focal VAs may arise from the LV adjacent to the membranous septum as a part of the LV ostium, and broadens the spectrum of LV ostium VAs.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
Plumb
Vance J
VJ
McElderry
Hugh Thomas
HT
Doppalapudi
Harish
H
Epstein
Andrew E
AE
Kay
George Neal
GN
D002036:Bundle of His / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000503:physiopathology* / Q000601:surgery; D018879:Ventricular Premature Complexes / Q000503:physiopathology* / Q000601:surgery; D054088:Ventricular Septum / Q000503:physiopathology*