Idiopathic ventricular arrhythmias originating from the left ventricular summit anatomic concepts relevant to ablation

Takumi Yamada, H. Thomas McElderry, Harish Doppalapudi, Taro Okada, Yoshimasa Murakami, Yukihiko Yoshida, Naoki Yoshida, Yasuya Inden, Toyoaki Murohara, Vance J. Plumb, G. Neal Kay

Research output: Contribution to journalArticlepeer-review

164 Scopus citations

Abstract

Background-The summit of the left ventricle (LV) is the most superior portion of the epicardial LV bounded by an arc from the left anterior descending coronary artery, superior to the first septal perforating branch to the left circumflex coronary artery. Ventricular arrhythmias (VAs) originating from this region may present challenges for catheter ablation. Methods and Results-We studied 27 consecutive patients with VAs originating from the LV summit. The great cardiac vein (GCV) divides this region between an inferior area accessible to ablation and a superior, inaccessible area. Successful ablation was achieved within the GCV in 14 patients and on the epicardial surface in 4. Ventricular prepotentials were recorded at the successful ablation site in 80% of these patients. In 5 patients, ablation was abandoned because of inaccessibility of the catheter to the myocardium or high impedance with radiofrequency application within the GCV. In the remaining 4 patients, epicardial mapping suggested VA origins in a region of low voltage that was located superior to the GCV (inaccessible area), and ablation was abandoned because of close proximity to the coronary arteries or high impedance. A right bundle-branch block, transition zone, R-wave amplitude ratio in leads III to II, Q-wave amplitude ratio in leads aVL to aVR, and S waves in lead V6 accurately predicted the site of origin. Conclusions-LV summit VAs may be ablated within the GCV or inferior to the GCV on the epicardial surface, though sites superior to the GCV are usually inaccessible to ablation.

Original languageEnglish (US)
Pages (from-to)616-623
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume3
Issue number6
DOIs
StatePublished - Dec 2010
Externally publishedYes

Keywords

  • Epicardial
  • Great cardiac vein
  • Idiopathic ventricular arrhythmia
  • Left ventricular summit
  • Radiofrequency catheter ablation

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