Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways.
Multiple mechanisms have been proposed for idiopathic premature ventricular contractions (PVCs) originating from the outflow tracts (OTs). Recent observations such as the coexistence of these arrhythmias with atrioventricular nodal reentrant tachycardias and the association between discrete prepotentials and successful ablation sites of ventricular arrhythmias (VAs) from the OTs suggest a common link.



In this case series we draw attention to a unique association between accessory pathways (APs) and idiopathic PVCs from the OTs, disappearing after AP ablation.



We identified 6 cases in collaboration with several international electrophysiology centers, which presented with pre-excitation in association with OT, and in 1 case inflow tract (IT), PVCs on 12-lead surface ECG.



Six cases displayed pre-excitation and PVCs, in 5 cases originating from the right ventricular outflow tract (RVOT) and in 1 case from the right ventricular inflow tract (RVIT). In all patients, PVCs were monomorphic and had fixed coupling intervals, in 3 cases presenting in bigeminy. Catheter ablation of the AP led to the simultaneous disappearance of PVCs in 5 of 6 cases. The sites of ablation were remote from the OTs in all these cases. In most cases, the occurrence of OT PVCs was closely associated with the presence of pre-excitation.



The coexistence of pre-excitation and PVCs from the OTs and the fact that in 5 of 6 cases PVCs disappeared after AP ablation suggests a common mechanism for arrhythmia genesis.
Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Tamas
T
Szili Torok
Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Lennart J
LJ
DE Vries
Department of Cardiology, School of Medicine Department of Cardiology, Balçova, Izmir, Turkey.
Emin E
EE
Özcan
Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
Can
C
Hasdemir
Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
Zsuzsanna
Z
Kis
Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
Attila
A
Kardos
Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
Tamas
T
Géczy
Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
Istvan
I
Kovacs
Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
Imre
I
Benedek
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Erik
E
Oosterwerff
Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.|Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Astrid A
AA
Hendriks
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Muchtiar
M
Khan
Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Sing-Chien
SC
Yap
D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
accessory pathway; case series; catheter ablation; idiopathic ventricular arrhythmias; international