title: Electrophysiological and electrocardiographic predictors of ventricular arrhythmias originating from the left ventricular outflow tract within and below the coronary sinus cusps.
abstract: OBJECTIVE
  Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can originate from within or below the aortic sinus of valsalva (ASV). Mapping and ablation below the ASV is challenging and there are limited data predicting VA origins using electrocardiographic and electrophysiological features.
  
  
  METHODS
  Thirty-four patients (56.7 ± 15.2 years; 19 males) with symptomatic VAs were analyzed. VA origins were determined by successful ablation. Patients were classified into 2 groups (group 1, VAs within the ASV; group 2, VAs below the ASV). Local activation and QRS morphology were compared between these 2 groups.
  
  
  RESULTS
  Twelve patients were classified as group 1 and 22 as group 2. Presystolic potentials (PPs) during VAs were present in 11 patients (91 %) in group 1 and 3 (13 %) in group 2. S-wave amplitude and duration in lead I were lower and shorter in group 1 vs. group 2, respectively. Q-wave aVL/aVR ratio (Q-aVL/aVR) was smaller in group 1 vs. group 2. No group 1 patients had Q-aVL/aVR >1.45. PPs in the ASV was the strongest independent predictor for VAs originating within the ASV (OR: 30.003, P = 0.006).
  
  
  CONCLUSIONS
  Deeper and longer S-waves in lead I and Q-aVL/aVR >1.45 suggest VAs originating below the ASV. Local PPs strongly suggest an origin within the ASV. ECG characteristics combined with local PPs can be a practical guide for ablating LVOT-VAs.
authors: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany, kmasashi@fmu.ac.jp.
authors: Masashi
authors: M
authors: Kamioka
authors: Shibu
authors: S
authors: Mathew
authors: Tina
authors: T
authors: Lin
authors: Andreas
authors: A
authors: Metzner
authors: Andreas
authors: A
authors: Rillig
authors: Sebastian
authors: S
authors: Deiss
authors: Peter
authors: P
authors: Rausch
authors: Christine
authors: C
authors: Lemes
authors: Hisaki
authors: H
authors: Makimoto
authors: Hesheng
authors: H
authors: Hu
authors: Dongpo
authors: D
authors: Liang
authors: Erik
authors: E
authors: Wissner
authors: Roland Richard
authors: RR
authors: Tilz
authors: Karl-Heinz
authors: KH
authors: Kuck
authors: Feifan
authors: F
authors: Ouyang
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods*; D054326:Coronary Sinus / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology*; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000503:physiopathology*
references: J Am Coll Cardiol. 2007 Aug 28;50(9):884-91
references: 17719476
references: Heart Rhythm. 2012 Jun;9(6):865-73
references: 22306618
references: Circ Arrhythm Electrophysiol. 2009 Dec;2(6):660-6
references: 20009078
references: Circ J. 2010 Feb;74(2):256-61
references: 20009358
references: J Am Coll Cardiol. 1994 May;23(6):1333-41
references: 8176091
references: Circulation. 2013 Apr 2;127(13):1359-68
references: 23439513
references: Circ Arrhythm Electrophysiol. 2008 Dec;1(5):396-404
references: 19808434
references: J Cardiovasc Electrophysiol. 2008 May;19(5):495-501
references: 18266673
references: Circ Arrhythm Electrophysiol. 2010 Dec;3(6):616-23
references: 20855374
references: Circulation. 2006 Apr 4;113(13):1659-66
references: 16567566
references: J Cardiovasc Electrophysiol. 2003 Dec;14(12):1280-6
references: 14678101
references: J Am Coll Cardiol. 2008 Jul 8;52(2):139-47
references: 18598894
references: J Am Coll Cardiol. 2000 Jun;35(7):1905-14
references: 10841242
references: J Am Coll Cardiol. 2006 Nov 7;48(9):1813-7
references: 17084255
references: Pacing Clin Electrophysiol. 2000 Nov;23(11 Pt 2):1930-4
references: 11139960
references: Clin Res Cardiol. 2014 Apr;103(4):315-7
references: 24322783
references: J Cardiovasc Electrophysiol. 2010 Feb;21(2):170-6
references: 19804552
references: Circ Arrhythm Electrophysiol. 2014 Jun;7(3):445-55
references: 24795340
references: Clin Res Cardiol. 2014 Dec;103(12):1025-7
references: 25060341
references: Pacing Clin Electrophysiol. 2005 Jan;28 Suppl 1:S150-4
references: 15683485
references: Herz. 2007 May;32(3):226-32
references: 17497256
references: J Am Coll Cardiol. 2002 Feb 6;39(3):500-8
references: 11823089