BACKGROUND Idiopathic ventricular arrhythmias (IVAs) can originate from the distal great cardiac vein (DGCV). However, inadequate distinction sometimes occurs when electrocardiographic (ECG) characteristics are used to distinguish ventricular arrhythmias (VAs) arising from the DGCV from those arising from the adjacent left ventricular endocardium (LV ENDO).OBJECTIVE The purpose of this study was to identify distinct ECG features in patients with idiopathic IVAs originating from the DGCV.METHODS A total of 32 patients with IVAs originating from the DGCV were identified from a consecutive group of 874 patients undergoing IVAs ablation. Patients with IVAs from the DGCV were compared with a consecutively chosen series of 40 patients with IVAs in whom the site of origin was the adjacent LV ENDO. RESULTSOf the 32 patients with IVAs arising from the DGCV, 13 had distinct ECG characteristics compared with the LV ENDO group.Notches in both the upstroke and downstroke of the R wave in lead III were found in all 13 patients. However, the characteristic ECG pattern in lead III was found in 1 of 40 patients in the LV ENDO group. The ECG characteristic of both early notch and late notches in lead III has sensitivity of 40.6%, specificity of 97.5%, negative predictive value of 67.2%, and positive predictive value of 92.9% to predict VAs arising from the DGCV.CONCLUSION The distinct ECG characteristics of VAs originating from the DGCV can help differentiate from adjacent LV ENDO sites of origin.

BackgroundLeft atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device.Materials and methodsA total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients’ clinical events were evaluated during the perioperative and follow-up periods.ResultsThe median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53–73], 3 [2–4], and 2 [2–3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325–865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients.ConclusionLAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.

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