Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from the Left Ventricular Summit Near the Left Main Coronary Artery

Takumi Yamada, Harish Doppalapudi, Silvio H. Litovsky, H. Thomas McElderry, G. Neal Kay

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background - 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. Methods and Results - 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. Conclusions - 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.

Original languageEnglish (US)
Article numbere004202
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 American Heart Association, Inc.

Keywords

  • catheter ablation
  • coronary artery
  • endocardium
  • epicardium
  • ventricular tachycardia

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