Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract

Noda, Takashi; Shimizu, Wataru; Taguchi, Atsushi; Aiba, Takeshi; Sato, Kazuhiro; Suyama, Kazuhiro; Kurita, Takashi; Aihara, Naohiko; Kamakura, Shiro

doi:10.1016/j.jacc.2005.05.077

Cited by 260 publications

(199 citation statements)

References 28 publications

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“…[22] In contrast, the "malignant" PA-VT in this study appeared to be provoked by the catecholaminergic / tachycardia -dependent mechanism, because the preceding R-R interval was markedly abbreviated (Table 2). Based on these studies [12,13,18,20] and ours, there might be at least two types of idiopathic polymorphic VT / VF arising from RVOT area.…”

Section: Discussionsupporting

confidence: 54%

“…[20] In contrast, Noda et al found that the malignant type exhibited a shorter cycle length of VT with no significant differences in the coupling interval. [18] In the present study, both the coupling interval and the (minimum) cycle length of VT were significantly shorter in the "malignant" PA-VT compared to the "benign" looking RVOT-VT.…”

Section: Discussionsupporting

confidence: 43%

“…[16,17] In contrast, it has been reported that a small number of patients develop polymorphic VT and /or VF, thereby suggesting the malignant entity. [12,13,[18][19][20] There are several studies attempting to differentiate such a malignant form of RVOT-VT from a benign one. Viskin et al reported that the malignant type had short-coupled premature extrasystoles which initiated the polymorphic VT and / or VF.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

et al. 2015

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AbstractsPanoptic studies of ventricular tachycardia (VT) originating above the pulmonary valve are scarce. The purpose of this study is to clarify the characteristic of idiopathic VT arising above pulmonary valve. We analyzed 15 consecutive patients with idiopathic VT that was successfully abolished by catheter ablation at the right ventricular outflow tract (RVOT-VT, n = 11) and above the pulmonary valve (PA-VT, n = 4). Incidence of syncope was higher in PA-VT than RVOT-VT (100 % vs 27 %, P < 0.05) and polymorphic VT was also more prevalent in PA-VT (75 % vs 0 %, P < 0.05). The coupling interval (315 ± 29 ms vs 449 ± 32 ms, mean ± SE) at the onset of VT and minimum cycle length (CL) (192 ± 13 ms vs 344 ± 37 ms) during VT were shorter in PA-VT (both P < 0.05). Among 12-lead ECG parameters, only R-wave amplitude in lead II was different between groups (2.05 ± 0.17 mV in PA-VT vs 1.44 ± 0.05 mV in RVOT-VT, P < 0.005). At the successful ablation site, the activation time from the onset of QRS complex did not differ between groups ( -37 ± 3 ms vs -31 ± 4 ms, P = 0.405), whereas the amplitude of intracardiac electrograms was significantly lower in PA-VT (0.83 ± 0.38 mV vs 2.39 ± 0.36 mV, P < 0.05). Although the number of patients in this study is limited, VT originating above the pulmonary valve demonstrated rapid excitation and often degenerated into polymorphic VT, suggesting its malignant electrophysiological characteristics.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

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Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

et al. 2015

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“…Noda et al reported 16 patients who had idiopathic VF arising from the RVOT, with all patients successfully treated with RFA without recurrence (mean follow-up of 54 months) [5]. Haissaguerre et al reported 27 patients who had idiopathic VF, 23 of which had VF arising from the Purkinje conducting system.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past 6 to 8 years, there has also been the description and growing recognition of patients with VF that has a focal origin. The majority of these seem to originate from the right ventricular outflow tract (RVOT) [3][4][5]. Other foci include sites in the right ventricle (RV) outside the RVOT and sites in the left ventricle (LV).…”

Section: Introductionmentioning

confidence: 99%

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Suh

Fowler

Yeh

et al. 2009

J Interv Card Electrophysiol

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Sudden cardiac death from ventricular fibrillation (VF) typically occurs in patients with structural heart disease, but in 5 to 10 percent VF is "idiopathic," occurring in normal hearts. Recently, there has been the description and growing recognition of patients with VF that has a focal origin, the common sites being in the right ventricular outflow tract (RVOT) and sites in the left ventricle. A focus within the right ventricle outside the RVOT is rare. We present a case of a woman with VF storm that was localized to the inferobasal right ventricle and was successfully treated with radiofrequency ablation.

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Cardiac and Natural Causes of Sudden Death

Karch

Fineschi

Riezzo

2009

Wiley Encyclopedia of Forensic Science

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In most jurisdictions of Western societies, sudden and unexpected deaths are mainly due to natural causes linked with heart diseases by an initiating factor triggering cardiac arrest. The aim is to provide a background of facts currently known or believed with a critical review to aid the reader in resolving cases for which he or she is responsible. In other words, we revisit pathologic findings versus etiopathogenetic hypotheses and theories and propose new ones substantiated by previously misinterpreted or ignored facts. In this article, detailed findings are presented along with overall interpretations in order to help the forensic pathologist in a court of law to act as interpreter of the sequence of events leading to death. Sudden death due to cardiovascular causes is uncommon among the young, yet we provide insight as to cause. The incidence of cardiovascular disease increases with increasing age, and, as indicated above, it is now the leading cause of morbidity and death in Western societies. In reaching conclusions, a forensic pathologist must correlate and discriminate between terminal events and pathological findings that denote preexisting cardiac disease. It is insufficient to rely upon the tendency to believe (erroneously) that current clinical imaging techniques are alone sufficient to provide evidence of the cause of a disease. Advances in technology will procure a histo‐ultrastructural view in living people. At present, however, the autopsy remains the gold standard, with the proviso that the diminishing requests for postmortem examination by clinicians may, in the future, confine autopsy investigation to forensic institutions. There is, therefore, a need to establish strict collaboration between clinicians and pathologists.

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Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract

Abstract: Our data suggest that the malignant entity of idiopathic VF and/or polymorphic ventricular tachycardia was occasionally present in patients with idiopathic ventricular arrhythmias arising from the RVOT. Radiofrequency catheter ablation was effective as a treatment option for this entity.

Cited by 260 publications

References 28 publications

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Successful catheter ablation of focal ventricular fibrillation originating from the right ventricle

Cardiac and Natural Causes of Sudden Death

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