TY - JOUR
T1 - Electrocardiographic characteristics of ventricular arrhythmias originating from the junction of the left and right coronary sinuses of Valsalva in the aorta
T2 - The activation pattern as a rationale for the electrocardiographic characteristics
AU - Yamada, Takumi
AU - Yoshida, Naoki
AU - Murakami, Yoshimasa
AU - Okada, Taro
AU - Muto, Masahiro
AU - Murohara, Toyoaki
AU - McElderry, Hugh T.
AU - Kay, G. Neal
PY - 2008/2
Y1 - 2008/2
N2 - Background: Ventricular arrhythmias (VAs) may arise from the aortic sinuses and have electrocardiographic and electrophysiological characteristics that suggest a left (LCC) or right coronary cusp (RCC) origin. However, VAs that arise near the junction of those two cusps (L-RCC) may have unusual features. Objectives: The purpose of this study was to examine the electrocardiographic and electrophysiological characteristics of VAs arising from the L-RCC. Methods: We studied 155 patients with idiopathic VAs with either left or right bundle branch block and an inferior QRS axis morphology and five control subjects undergoing a pacing study. Results: For 146 of the 155 patients, the origin determined by the successful ablation site was at the L-RCC in five, LCC in 13, RCC in six, non-coronary cusp in two, right ventricular outflow tract in 108, left ventricular outflow tract in five, left ventricular epicardium in four, and pulmonary artery in three. A qrS pattern in leads V1-V3 was observed only in the VAs with an L-RCC origin. The propagation map revealed that the direction of the propagating wave front from the L-RCC origin produced a vector compatible with a q wave and that the anterior activation to the right ventricular outflow tract via the LCC or RCC formed the r wave. Pacing performed at multiple sites in the aortic root in the control subjects demonstrated that only pacing from the L-RCC could reproduce a qrS pattern in leads V1-V3. Conclusions: This study revealed that a qrS pattern in leads V1-V3 suggests a site of origin at the L-RCC.
AB - Background: Ventricular arrhythmias (VAs) may arise from the aortic sinuses and have electrocardiographic and electrophysiological characteristics that suggest a left (LCC) or right coronary cusp (RCC) origin. However, VAs that arise near the junction of those two cusps (L-RCC) may have unusual features. Objectives: The purpose of this study was to examine the electrocardiographic and electrophysiological characteristics of VAs arising from the L-RCC. Methods: We studied 155 patients with idiopathic VAs with either left or right bundle branch block and an inferior QRS axis morphology and five control subjects undergoing a pacing study. Results: For 146 of the 155 patients, the origin determined by the successful ablation site was at the L-RCC in five, LCC in 13, RCC in six, non-coronary cusp in two, right ventricular outflow tract in 108, left ventricular outflow tract in five, left ventricular epicardium in four, and pulmonary artery in three. A qrS pattern in leads V1-V3 was observed only in the VAs with an L-RCC origin. The propagation map revealed that the direction of the propagating wave front from the L-RCC origin produced a vector compatible with a q wave and that the anterior activation to the right ventricular outflow tract via the LCC or RCC formed the r wave. Pacing performed at multiple sites in the aortic root in the control subjects demonstrated that only pacing from the L-RCC could reproduce a qrS pattern in leads V1-V3. Conclusions: This study revealed that a qrS pattern in leads V1-V3 suggests a site of origin at the L-RCC.
KW - Aortic sinus cusp
KW - Electroanatomic mapping
KW - Radiofrequency catheter ablation
KW - Ventricular arrhythmia
UR - http://www.scopus.com/inward/record.url?scp=38649121755&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=38649121755&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2007.09.029
DO - 10.1016/j.hrthm.2007.09.029
M3 - Article
C2 - 18242537
AN - SCOPUS:38649121755
SN - 1547-5271
VL - 5
SP - 184
EP - 192
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -