Catheter Ablation of Idiopathic Premature Ventricular Contractions and Ventricular Tachycardias Originating from Right Ventricular Septum

Abstract

BackgroundIdiopathic premature ventricular contractions (PVCs) and ventricular tachycardias (IVTs) originating from the subtricuspid septum and near the His bundle have been reported. However, little is known about the prevalence, distribution, electrocardiographic characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for the ventricular arrhythmias arising from the right ventricular (RV) septum. This study aimed to investigate electrocardiographic characteristics and effects of RFCA for patients with symptomatic PVCs/IVTs, originating from the different portions of the RV septum.Methodology/Principal FindingsCharacteristics of body surface electrocardiogram and electrophysiologic recordings were analyzed in 29 patients with symptomatic PVCs/IVTs originating from the RV septum. Among 581 patients with PVCs/IVTs, the incidence of ventricular arrhythmias originating from the RV septum was 5%. Twenty (69%) had PVCs/IVTs from the septal portion of the tricuspid valvular RV region (3 from superoseptum, 15 from midseptum, 2 from inferoseptum), and 9 (31%) from the septal portion of the basal RV (1 from superoseptum, 4 from midseptum, 4 from inferoseptum). There were different characteristics of ECG of PVCs/VT originating from the different portions of the RV septum. Twenty-seven of 29 patients with PVCs/IVTs arising from the RV septum were successfully ablated (93.1% acute success).Conclusions/SignificanceECG characteristics of PVCs/VTs originating from the different portions of the RV septum are different, and can help regionalize the origin of these arrhythmias. The septal portion of the tricuspid valvular RV region was the preferential site of origin. RFCA was effective and safe for the PVCs/IVTs arising from the RV septum.

Slow pathway region as the exit site of parahisian premature ventricular contractions: Why choose safety over the earliest activation?

“…Several series reported a higher likelihood of abandoning attempts at ablation of parahisian PVCs due to the possibility of inducing AV block . In this particular patient, LBBB in sinus rhythm increases this concern.…”

“…According to Enrique et al, the presence of a positive QRS in lead II with negative QRS in III is associated with particular RV anatomical locations, namely, the parahisian region in the majority of patients. Lian‐Pin et al proposed that the earlier precordial R‐wave transition (<V4) is more common in PVCs arising from the tricuspid valvular septum than the basal RV septum because the origin of VAs in the former was located in the more posterior portion of the RV. Finally, Briceño et al described exactly the same electrocardiographic characteristics we found in SPR VAs.…”

Ventricular Tachycardia Originating from the Septal Papillary Muscle of the Right Ventricle: Electrocardiographic and Electrophysiological Characteristics

“…RV septal PVCs have been described by Lian‐Pin et al . in a case series of 29 patients . They found that all PVCs had an rS or QS pattern in lead V1 and an LBBB morphology.…”

Radiofrequency catheter ablation of premature ventricular contractions from the mitral annulus in patients without structural heart disease

“…It may be hard for the ablation catheter to reach the LA using the trans‐aortic approach (Figure 2E). Moreover, in the remaining two patients (9%) with an unsuccessful procedure, successful results could not be achieved even though a trans‐aortic approach was additionally performed 8 (Figure 2F). The trans‐aortic approach was not considered to be able to gain stronger support and contact force than the trans‐interatrial septal approach.…”

“…The trans-aortic approach was not considered to be able to gain stronger support and contact force than the trans-interatrial septal approach. Further, the remaining one patient (5%) underwent a successful procedure that could be achieved from a coronary sinus approach 6,8 (Figure 2E (Table 3). Especially, the high-density mapping catheter is the only directional high-density mapping catheter that cannot only identify the local electrical signals but also more importantly can capture…”