title: Ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps: mapping and catheter ablation via transseptal approach and electrocardiographic characteristics.
abstract: BACKGROUND
  Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach.
  
  
  RESULTS
  This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. Radiofrequency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-wave amplitude ratio >1.4 in 7, lead III/II R-wave amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months.
  
  
  CONCLUSIONS
  The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofrequency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.). ouyangfeifan@gmail.com.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Shulin
authors.initials: S
authors.lastname: Wu
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Masashi
authors.initials: M
authors.lastname: Kamioka
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Yumei
authors.initials: Y
authors.lastname: Xue
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Xianzhang
authors.initials: X
authors.lastname: Zhan
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Peter
authors.initials: P
authors.lastname: Rausch
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Sebastian
authors.initials: S
authors.lastname: Deiß
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Christine
authors.initials: C
authors.lastname: Lemes
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Tönnis
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People's Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.).
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012850:Sinus of Valsalva / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ablation; catheters; mapping; ventricular arrhythmias