Common and distinctive electrocardiographic characteristics and effective catheter ablation of idiopathic ventricular arrhythmias originating from different areas of ventricular septum adjacent to atrioventricular annulus

Zhang, Suqin; Cheng, Zheng; Li, Yuechun; Ji, Kangting; Yin, Rong‐Hua; Lin, Jiafeng; Li, Jia

doi:10.1111/jce.13638

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…A number of studies (Chen et al, 2018; Wu et al, 2013; Xu et al, 2018; Zhang et al, 2018, 2019) have shown that PVCs originating from the tricuspid annulus reflected extensive ECG characteristics; most I, aVL, V 5 , and V 6 leads reflected unidirectional R‐waves, and the amplitude of the R‐wave in lead I was larger than the R‐wave in the sinus rhythm. However, the anterior lead may indicate different characteristics.…”

Section: Discussionmentioning

confidence: 99%

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The characteristics of a 12‐lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method

Guo

Zhang

et al. 2022

Noninvasive Electrocardiol

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The clinical manifestations of ventricular arrhythmias vary from being asymptomatic in mild cases to sudden cardiac death in severe instances by impacting the function and structure of the heart pumping cycle (Ge et al., 2017;Wen et al., 2015). The origins of ventricular arrhythmias are significantly correlated with age and sex (Tanaka et al., 2011). However, with respect to the nonoutflow tract ablation of premature ventricular contractions (PVCs), whether for children or adults, catheter ablation has demonstrated objective safety and effectiveness in successfully reducing or even eliminating the occurrence of arrhythmias (Gao et al., 2017).

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Section: Discussionmentioning

confidence: 99%

“…A number of studies (Chen et al, 2018;Wu et al, 2013;Xu et al, 2018;Zhang et al, 2018Zhang et al, , 2019 Lu (Lu et al, 2016) reported that the ECG features of the tricuspid annulus and PVCs originating in the RVOT junction were as follows:…”

Section: Ta B L E 1 Baseline Patient Datamentioning

confidence: 99%

The characteristics of a 12‐lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method

Guo

Zhang

et al. 2022

Noninvasive Electrocardiol

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“…Briefly, it could be described as three steps. Step 1: Pre-judgement of left or right PHVAs according to the QRS morphology in lead V1 and precordial transitional zone ( 13 ). The “R”/“qR(s)” pattern in V1 and precordial transitional zone ≤ V1 indicated a left PHVA.…”

Section: Methodsmentioning

confidence: 99%

A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

Kong

Tian

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.

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“…Most VAs have an aortic root, left ventricular (LV) septum, or right ventricular outflow tract origin [ 1 , 4 , 5 ]. However, about 5% to 10% of VAs have a rare origin adjacent to the mitral annulus (MA) [ 6 , 7 ]. MA-VAs can be divided into epicardial MA-VAs and endocardial MA-VAs, which are very different in the ablation treatment [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus

Lin

Cheng

et al. 2023

JCDD

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Background: This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). Methods: This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively. Results: The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively. Conclusion: the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia’s origin and designing the ablation plan accordingly.

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Common and distinctive electrocardiographic characteristics and effective catheter ablation of idiopathic ventricular arrhythmias originating from different areas of ventricular septum adjacent to atrioventricular annulus

Abstract: Distinctive ECG characteristics of PVCs/IVTs originating from VS-AVA aid in origin localization guiding effective RFCA.

Cited by 7 publications

References 19 publications

The characteristics of a 12‐lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method

The characteristics of a 12‐lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method

A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation

Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus

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