title: Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation.
abstract: BACKGROUND
  The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs).
  
  
  OBJECTIVE
  The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS.
  
  
  METHODS
  Detailed activation and pace-mapping of the right ventricle (RV), left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation.
  
  
  RESULTS
  Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 ± 15) had earliest activation in the CVS, 39 ± 18 ms before QRS. Twenty-five (53%) were in the great cardiac vein, 19 (40%) in the anterior interventricular vein, and 3 (7%) in the middle cardiac vein. We ablated inside CVS in 32 patients (68%) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32%), who underwent ablation from adjacent left sinus of Valsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94%) ablated at the earliest CVS site and in 16 of 29 (55%) ablated at adjacent CVS or non-CVS sites.
  
  
  CONCLUSIONS
  Idiopathic VAs are occasionally (9%) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62%) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55% of these anatomically challenging cases, for an overall ablation success rate of 70%.
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania,; Lenox Hill Heart and Vascular Institute of New York, North Shore-LIJ Health System, New York, New York.
authors.forename: Stavros E
authors.initials: SE
authors.lastname: Mountantonakis
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania,. Electronic address: francis.marchlinski@uphs.upenn.edu.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000601:surgery; D006328:Cardiac Catheterization; D017115:Catheter Ablation; D017023:Coronary Angiography; D054326:Coronary Sinus / Q000033:anatomy & histology; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000503:physiopathology; D014680:Veins / Q000503:physiopathology
keywords: Catheter ablation; Coronary venous system; Ventricular premature depolarization; Ventricular tachycardia