title: Prevalence and clinical, electrocardiographic, and electrophysiologic characteristics of ventricular arrhythmias originating from the noncoronary sinus of Valsalva.
abstract: BACKGROUND
  Idiopathic ventricular arrhythmias (VAs) can be rarely ablated from the noncoronary cusp (NCC) of the aorta.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the prevalence and the clinical, electrocardiographic, and electrophysiologic characteristics of idiopathic NCC VAs.
  
  
  METHODS
  We studied 90 consecutive patients who underwent successful catheter ablation of idiopathic aortic root VAs (left coronary cusp [LCC] 33, right coronary cusp [RCC] 32, junction between LCC and RCC 19, NCC = 6).
  
  
  RESULTS
  NCC VAs occurred in significantly younger patients (all <40 years old) and exhibited a shorter QRS duration (all but one <150 ms), smaller R-wave amplitude ratio in leads II and III (III/II), earlier ventricular activation in the His bundle (HB) region (all but one preceded QRS onset by >25 ms), and larger atrial to ventricular electrogram amplitude ratio (A/V) at the successful ablation site (all but one >1) than the other VAs. QRS morphology of the NCC VAs was similar to that of RCC VAs, but NCC VAs always exhibited a left bundle branch block and left superior (n = 1) or inferior axis (n = 5). All NCC VAs exhibited ventricular tachycardias, although premature ventricular contractions were dominant in the other VAs.
  
  
  CONCLUSIONS
  NCC VAs were very rare (7%) and occurred in significantly younger patients than those among the other aortic root VAs. In a limited set of six patients, the ECG and electrophysiologic characteristics of NCC VAs were similar to those of RCC VAs but were characterized by narrower QRS duration, smaller III/II ratio, earlier ventricular activation in the HB region, and A/V ratio >1 at the successful ablation site.
authors: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: takumi-y@fb4.so-net.ne.jp.
authors: Takumi
authors: T
authors: Yamada
authors: Yung R
authors: YR
authors: Lau
authors: Silvio H
authors: SH
authors: Litovsky
authors: H
authors: H
authors: Thomas McElderry
authors: Harish
authors: H
authors: Doppalapudi
authors: Jose
authors: J
authors: Osorio
authors: Vance J
authors: VJ
authors: Plumb
authors: G
authors: G
authors: Neal Kay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama / Q000453:epidemiology; D004562:Electrocardiography; D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012850:Sinus of Valsalva / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology*; D055815:Young Adult
keywords: ASC; Characteristics; HB; His bundle; LCC; LV; NCC; Noncoronary cusp; PVC; Prevalence; RCC; RF; RV; RVOT; Radiofrequency catheter ablation; VA; VT; Ventricular arrhythmia; aortic sinus cusp; left coronary cusp; left ventricle; noncoronary cusp; premature ventricular contraction; radiofrequency; right coronary cusp; right ventricle; right ventricular outflow tract; ventricular arrhythmia; ventricular tachycardia