title: Ventricular arrhythmias near the distal great cardiac vein: challenging arrhythmia for ablation.
abstract: BACKGROUND
  Catheter ablation for ventricular arrhythmia (VA) near the distal great cardiac vein (GCV) is often challenging, and data are limited.
  
  
  RESULTS
  Analysis was performed in 30 patients (19 men; age, 52.8±15.5 years) who underwent catheter ablation for focal VA (11 ventricular tachycardia and 19 premature contractions) with early activation in the GCV (36.7±8.0 ms pre-QRS). Angiography in 27 patients showed earliest GCV site within 5 mm of a coronary artery in 20 (74%). Ablation was performed in the GCV in 15 patients and abolished VA in 8. Ablation was attempted at adjacent non-GCV sites in 19 patients and abolished VA in 5 patients (4 from the left ventricular endocardium and 1 from the left coronary cusp); all success had VA with an initial r wave in lead I and activation ≤7 ms after the GCV (GCV-non-GCV interval). In 13 patients, percutaneous epicardial mapping was performed, but because of adjacent coronaries only 2 received radiofrequency application with VA elimination in 1. Surgical cryoablation was performed in 3 patients and abolished VA in 2. Overall acute success was achieved in 16 (53%) patients. After a median of 2.8 months, 13 patients remained free of VA. Major complications occurred in 4 patients, including coronary injury requiring stenting.
  
  
  CONCLUSIONS
  Ablation for this arrhythmia is challenging and often limited by the adjacent coronary vessels. Success of anatomically guided endocardial ablation may be identified by a short GCV-non-GCV interval and r wave in lead I.
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Kaity Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. wstevenson@partners.org.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006335:Heart Injuries / Q000209:etiology; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: catheter ablation; premature ventricular contraction; ventricular tachycardia