title: Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery.
abstract: Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs.
  
  
  
  Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied. RFCA was successful within the main trunk of the GCV in 16 patients and within a branch of the GCV traversing the basal LV (B-LV) summit in 7. Transpericardial RFCA was successful on the epicardial surface in the A-LV summit in 6 patients and was abandoned in 14 with the B-LV summit VAs because of the close proximity to the coronary arteries and thick fat pads. RFCA was successful at the aortomitral continuity in 3 patients (2 with a failed transpericardial RFCA), and left coronary cusp in 1. The RFCA success rate of the A-LV summit VAs including the GCV VAs was 100% (22/22), whereas that of the B-LV summit VAs was 48% (11/23). The B-LV summit VAs could be differentiated from the A-LV summit VAs by left bundle branch block pattern, QRS duration ≤175 ms, precordial transition ≥V1, and maximum deflection index of ≥0.55.
  
  
  
  This study revealed that ≈50% of the B-LV summit VAs could be eliminated by a direct approach through a GCV branch running below the proximal left coronary arteries and a remote approach from the adjacent endocardial sites.
authors.affiliation: From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham. takumi-y@fb4.so-net.ne.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham.
authors.forename: Harish
authors.initials: H
authors.lastname: Doppalapudi
authors.affiliation: From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham.
authors.forename: Silvio H
authors.initials: SH
authors.lastname: Litovsky
authors.affiliation: From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham.
authors.forename: H Thomas
authors.initials: HT
authors.lastname: McElderry
authors.affiliation: From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham.
authors.forename: G Neal
authors.initials: GN
authors.lastname: Kay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011846:Radio Waves; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: catheter ablation; coronary artery; endocardium; epicardium; ventricular tachycardia