Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus: Results of radiofrequency catheter ablation in thirty-five patients

Abstract

BackgroundIn recent years, catheter ablation has increasingly been used for ablation of idiopathic premature ventricular complexes (PVCs) or ventricular tachycardias (IVTs). However, the mapping and catheter ablation of the arrhythmias originating from the vicinity of tricuspid annulus (TA) may not be fully understood. This study aimed to investigate electrophysiologic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic PVCs and IVTs originating from the vicinity of TA.MethodsCharacteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 35 patients with symptomatic PVCs/ IVTs originating from the vicinity of TA. RFCA was performed using pace mapping and activation mapping.ResultsAmong the 35 patients with PVCs/IVTs arising from the vicinity of TA, complete elimination of PVCs/IVTs could be achieved by RFCA in 32 patients (success rate 91.43%) during a median follow-up period of 21 months. PVCs/IVTs originating from the vicinity of TA had distinctive ECG characteristics that were useful for identifying the precise origin. An rS pattern was recorded in lead V1 in 93.1% of patients with PVCs/IVTs from the free wall of TA, vs 16.7% of patients with PVCs/IVTs from the septal TA, whereas a QS pattern in lead V1 occurred in 83.3% of patients with PVCs/IVTs from the septal TA vs 6.9% of patients with PVCs from the free wall of the TA. The precordial R wave transition occurred by lead V3 or earlier in all patients with PVCs/IVTs originating from the septal portion of the TA, as compared to transition beyond V3 in all patients with PVCs/IVTs from the free wall of the TA.ConclusionsRFCA is an effective curative therapy for symptomatic PVCs/IVTs originating from the vicinity of TA. There are specific characteristics in ECG and the ablation site could be located by ECG analysis.

Trans-subclavian approach for radiofrequency ablation of premature ventricular contractions originating from subtricuspid annulus: a case report

“…A small number of cases of idiopathic VAs have been reported to originate from the tricuspid annulus [8]. Mapping and catheter ablation of the arrhythmias originating from the tricuspid annulus has been fully understood, and radiofrequency catheter ablation is an effective curative therapy for symptomatic PVCs originating from the vicinity of tricuspid annulus [9]. The standard catheter ablation procedure is performed via the femoral vein.…”

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

“…We and other investigators have recently demonstrated that QRS duration, R-wave transition in the precordial leads, QS pattern in lead V1, and polarity of the QRS complex in the inferior leads were useful to distinguish between PVCs/IVTs originating from the septal portion and free wall of tricuspid annulus [8], [9]. A monophasic tall R pattern in lead I, low R wave in leads II and aVF, particularly lower R wave in lead III than in lead II, R wave in lead aVL, relatively narrow QRS duration, QS pattern in lead V1, and tall R wave in V5 and V6 suggest the PVCs/IVTs origin from the RV septum near the His-bundle [10].…”

Analysis of Morphological Characteristics and Origins of Idiopathic Premature Ventricular Contractions Under a 12-Lead Electrocardiogram in Children with Structurally Normal Hearts

“…With the development of electrophysiology and radiofrequency ablation, several studies [9][10][11][12][13] have described the criteria to distinguish PVC origin according to the features of the 12-lead electrocardiogram. Site-specific crite- ria of PVCs also have been reported in these studies.…”

“…This type of PVC is generally considered to be of tricuspid annulus origin. 11,16) 3) PVCs LBBB (RBBB)-I: a RBBB morphology with upward main QRS wave pattern in lead V1 and a large R pattern of QRS in leads II and III, and aVF is considered to be of LVOT origin.…”

“…7) PVCs usually originate in the right ventricular outflow tract (RVOT), tricuspid annulus, left ventricular anterior or posterior branch, mitral annulus, left ventricular outflow tract, aortic root, and epicardium. 8) Previous studies [9][10][11][12][13] showed that morphological characteristics under a 12-lead electrocardiogram had high diagnostic value for differentiating the origin of PVCs in the adult population. However, electrocardiographic characteristics and origin of idiopathic PVCs in children have not been fully clarified.…”