Endocardial ablation of ventricular ectopic beats arising from the basal inferoseptal process of the left ventricle

Li, Anthony; Zuberi, Zia; Bradfield, Jason S.; Zarif, John K.; Ward, David; Anderson, Robert H.; Shivkumar, Kalyanam; Saba, Magdi

doi:10.1016/j.hrthm.2018.04.029

Cited by 43 publications

(26 citation statements)

References 7 publications

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“…The anatomy of para‐Hisian region is complex and particular. Para‐Hisian VAs is suggested to be originated from the basal interventricular septum, which can be divided into anterior (superior), mid, and posterior (inferior) basal septum . From the right side, the basal ventricular septum is completely covered by the septal leaflet of the tricuspid valve .…”

Section: Discussionmentioning

confidence: 99%

“…The ECG morphology in inferior leads may predict the location of para‐Hisian VAs and guide catheter ablation. From anterior (superior) septum to mid and posterior (inferior) septum, the magnitude of R wave is gradually decreased and the magnitude of S (s) wave is gradually increased in inferior leads, especially in lead III . When ablation in the RV septum failed, mapping in aortic sinus cusps and left ventricular septum should be considered .…”

Section: Discussionmentioning

confidence: 99%

“…Para-Hisian VAs is suggested to be originated from the basal interventricular septum, which can be divided into anterior (superior), mid, and posterior (inferior) basal septum. [13][14][15] From the right side, the basal ventricular septum is completely covered by the septal leaflet of the tricuspid valve. 12 As a result, it is divided into supravalvular relatively unprotected to RF injury/AV block.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…From anterior (superior) septum to mid and posterior (inferior) septum, the magnitude of R wave is gradually decreased and the magnitude of S (s) wave is gradually increased in inferior leads, especially in lead III. [13][14][15]23 When ablation in the RV septum failed, mapping in aortic sinus cusps and left ventricular septum should be considered. 12 In this study, ablation in the RV failed to eliminate VAs in 3 of 25 patients and one of them achieved successful ablation in the RCC.…”

Section: Challenge In Catheter Ablation Of Para-hisian Vasmentioning

confidence: 99%

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Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Sun

Zhang

Wang

et al. 2019

Cardiovasc electrophysiol

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Aims Ventricular arrhythmias (VAs) originating from the para‐Hisian region represent a challenging location. The long‐term success rate of catheter ablation above the septal leaflet of the tricuspid valve is not ideal. This study aimed to investigate the safety and efficacy of catheter ablation for para‐Hisian VAs via a direct approach under the septal valve with reversed C‐curve technique. Methods and Results Twenty‐five consecutive patients with para‐Hisian VAs were included. Systematic mapping was performed in the right ventricle septum, including both the regions above and under the septal valve. Radiofrequency (RF) ablation was preferentially performed under the valve with reversed C‐curve technique in all patients. If the ablation failed under the valve, it was then performed above the valve and even in aortic sinus cusps. The earliest ventricular activation preceding surface QRS (V‐QRS) under the valve was significantly larger than that above the valve (34.8 ± 5.3 vs 27.8 ± 5.7 ms, P < .01). RF ablation under the valve with reversed C‐curve technique achieved acute success in 22 of 25 (88%) patients. Junctional rhythm developed during ablation in 3 of 25 (12%) patients and no atrioventricular block occurred. In the remaining three patients, RF application above the valve failed to eliminate the VAs and one of them achieved successful ablation in the right coronary cusp. During a mean follow‐up of 17.8 ± 9.4 months, no patients presented with VAs recurrence and no postprocedure complications occurred. Conclusions Catheter ablation under the valve with reversed C‐curve technique shows to be effective and safe for para‐Hisian VAs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Challenge In Catheter Ablation Of Para-hisian Vasmentioning

confidence: 99%

See 2 more Smart Citations

Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Sun

Zhang

Wang

et al. 2019

Cardiovasc electrophysiol

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“…It lies between the aortic annulus (VBR) and that part of the left ventricle demarcated apically by the tip of the anterior mitral valve leaflet (AML) (Yacoub et al, 1999), the AML forming its posterior wall. A subportion of the left ventricule named the basal inferoseptal process has been described which was previously associated with the terms aortic vestibule and Sibson's vestibule (Li et al, 2018). This small space is best thought of as representing the septal extremity of the recess that lies between the posterior mitral leaflet and the left ventricular wall.…”

Section: Introductionmentioning

confidence: 99%

The aortic root hexagon as an aide memoire to the important surgical landmarks

et al. 2020

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Background: The anatomy of the aortic root and its relationship to cardiac landmarks is important for valve-sparing surgery and understanding the pathology of lesions arising in this structure. Rapid understanding of the key anatomical details can be achieved by a geometrical concept based on the shape of a hexagon. Methods: Definitions, structure, and key anatomical concepts of the aortic root according to the current literature were reviewed. Thirty pig hearts were dissected to explore the relationships of the six points on the aortic root. Six double 2/0 ethibond needles were placed into the six points at 90. The passage of the needles through the specific cardiac landmarks at each point was noted. The aortic root hexagon is a geometrical structure formed by two triangles superimposed on each other. The six points in the hexagon relate to important adjacent cardiac landmarks. Results: The two best-known anatomical relationships are of the left-non coronary aortic commissure to the longitudinal axis of symmetry of the aortic leaflet of the mitral valve and the relationship of the nadir of the noncoronary aortic valve leaflet to the medial commissure of the mitral valve. The other four points are related to equally significant and well defined anatomical landmarks. Conclusion: The aortic root hexagon is made by two triangles superimposed on each other, these are the commissural and nadir triangles respectively. We have found this concept to be a quick way to learn and remember the key anatomical relationships of the aortic root.

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The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

et al. 2021

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Conduction problems still occur following transcatheter aortic valvar replacement.With this in mind, we have assessed the relationship of the conduction axis to the aortic root. We used serial histological sections, made perpendicular to the base of the triangle of Koch in nine hearts, and perpendicular to the aortic root in 11 hearts.We first defined the extent of the fibrous tissues forming the boundaries of an infero-septal recess of the subaortic outflow tract, found in all datasets but one.When the recess was present, the axis penetrated through its rightward wall, giving rise to the left bundle branch prior to entering the outflow tract. The axis itself was usually on the crest of the ventricular septum, but could be deviated leftward or rightward. Its proximity to the virtual basal plane reflected the angulation of the muscular septum. On average, the superior edge of the left bundle was within 3.3 mm of the hinge of the right coronary leaflet, with a range from 0.4 to 10.2 mm. The arrangement was markedly different in the case lacking an infero-septal recess. Our findings necessitated a redefinition of the right fibrous trigone and the central fibrous body. The atrioventricular conduction axis, having entered the aortic root, is usually closest at the hinge of the right coronary leaflet. Knowledge of the depth of the infero-septal recess, and the angulation of the muscular ventricular septal, may help to avoid conduction problems following transcatheter implantation of the aortic valve.

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Endocardial ablation of ventricular ectopic beats arising from the basal inferoseptal process of the left ventricle

Cited by 43 publications

References 7 publications

Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique

The aortic root hexagon as an aide memoire to the important surgical landmarks

The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

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