Mechanistic subtypes of focal right ventricular tachycardia

Lerman, Bruce B.; Cheung, Jim W.; Ip, James E.; Liu, Christopher F.; Thomas, George; Markowitz, Steven M.

doi:10.1111/jce.13505

Cited by 10 publications

(6 citation statements)

References 41 publications

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“…VTs originating in the RVOT are commonly associated with focal mechanisms, including enhanced automaticity and cAMP-mediated triggered activity. 2 Moreover, the ectopic activity in the RVOT can be facilitated by catecholamines but seldom results in sustained VT, especially in nonpathological hearts. In our study, we combined infusion with isoproterenol with concurrent rapid pacing to achieve sustained VT.…”

Section: Discussionmentioning

confidence: 99%

“…The right ventricular outflow tract (RVOT) is a dominant site of origin of premature ventricular contractions (PVCs) and ventricular tachyarrhythmias including the Brugada syndrome, idiopathic ventricular arrhythmias, and arrhythmogenic right ventricular (RV) cardiomyopathy among others. 1,2 Anatomically, the RVOT is a thin, smooth-walled, tubular structure located between the pulmonary artery and inlet and apical components of the RV. The tissue structure is interspersed with heterogenous distribution of fibrous and fat tissue 3,4 and comprises a complex 3-dimensional network of cardiac fibers arranged circumferentially in the sub-epicardium and longitudinally in the sub-endocardium.…”

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confidence: 99%

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Electrophysiology and Arrhythmogenesis in the Human Right Ventricular Outflow Tract

Aras

Gams

Faye

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Right ventricular outflow tract (RVOT) is a common source of ventricular tachycardia, which often requires ablation. However, the mechanisms underlying the RVOT’s unique arrhythmia susceptibility remain poorly understood due to lack of detailed electrophysiological and molecular studies of the human RVOT. Methods: We conducted optical mapping studies in 16 nondiseased donor human RVOT preparations subjected to pharmacologically induced adrenergic and cholinergic stimulation to evaluate susceptibility to arrhythmias and characterize arrhythmia dynamics. Results: We found that under control conditions, RVOT has shorter action potential duration at 80% repolarization relative to the right ventricular apical region. Treatment with isoproterenol (100 nM) shortened action potential duration at 80% repolarization and increased incidence of premature ventricular contractions ( P =0.003), whereas acetylcholine (100 μM) stimulation alone had no effect on action potential duration at 80% repolarization or premature ventricular contractions. However, acetylcholine treatment after isoproterenol stimulation reduced the incidence of premature ventricular contractions ( P =0.034) and partially reversed action potential duration at 80% repolarization shortening ( P =0.029). Immunolabeling of RVOT (n=4) confirmed the presence of cholinergic marker VAChT (vesicular acetylcholine transporter) in the region. Rapid pacing revealed RVOT susceptibility to both concordant and discordant alternans. Investigation into transmural arrhythmia dynamics showed that arrhythmia wave fronts and phase singularities (rotors) were relatively more organized in the endocardium than in the epicardium ( P =0.006). Moreover, there was a weak but positive spatiotemporal autocorrelation between epicardial and endocardial arrhythmic wave fronts and rotors. Transcriptome analysis (n=10 hearts) suggests a trend that MAPK (mitogen-activated protein kinase) signaling, calcium signaling, and cGMP-PKG (protein kinase G) signaling are among the pathways that may be enriched in the male RVOT, whereas pathways of neurodegeneration may be enriched in the female RVOT. Conclusions: Human RVOT electrophysiology is characterized by shorter action potential duration relative to the right ventricular apical region. Cholinergic right ventricular stimulation attenuates the arrhythmogenic effects of adrenergic stimulation, including increase in frequency of premature ventricular contractions and shortening of wavelength. Right ventricular arrhythmia is characterized by positive spatial-temporal autocorrelation between epicardial-endocardial arrhythmic wave fronts and rotors that are relatively more organized in the endocardium.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Electrophysiology and Arrhythmogenesis in the Human Right Ventricular Outflow Tract

Aras

Gams

Faye

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…3 Premature ventricular contractions (PVCs) originate more often from the rim of ventricular tissue of the tricuspid annulus (TA) than from that of the mitral annulus. 4 Radiofrequency (RF) catheter ablation (RFCA) is an effective treatment method for PVCs and has been increasingly used for PVCs originating from the ventricular aspect of the TA. 5 Activation mapping is very important for the successful ablation of PVCs.…”

Section: Introductionmentioning

confidence: 99%

Unipolar and bipolar electrograms to predict successful ablation site of premature ventricular contractions originating from the free wall of the tricuspid annulus

Liu,

Tian,

Tian

et al. 2023

Cardiovasc electrophysiol

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IntroductionThis study aimed to identify the characteristics of unipolar and bipolar electrogram (UniEGM and BiEGM) in guiding successful ablation of premature ventricular contractions (PVCs) originating from the free wall of the ventricular aspect of the tricuspid annulus (TA). We hypothesized that the negative concordance pattern (NCP) on the onset of UniEGM and BiEGM, together with the least value of the difference between the earliest BiEGM and UniEGM dV/dTmax, might improve the accuracy of conventional mapping.Methods and ResultsThirty consecutive patients who underwent successful catheter ablation from February 2018 to July 2021 were retrospectively analyzed. The BiEGM and UniEGM for successful ablation sites were compared with those for non‐successful ablation sites. Among the 30 patients, 30 successful and 26 nonsuccessful ablation sites were compared. The earliest activation time of the BiEGM (BiEGMoneset‐QRS) was 25 ± 6 ms for the successful ablation sites and 21 ± 6 ms for the nonsuccessful ablation sites (p = .47). The value of the difference in the earliest BiEGM and UniEGM dV/dTmax differed between successful and nonsuccessful ablation sites (6.4 ± 3.6 ms vs. 10.4 ± 6.8 ms). NCP was observed at 90.0% and 42.3% of the successful and nonsuccessful ablation sites, respectively. Alignment of NCP and BiEGMonset‐UniEGM ≤6 ms was applied as the mapping criterion for successful PVC suppression (73.1% sensitivity and 87.7% specificity). The area under the receiver‐operating characteristic curve for this cutoff was 0.85.ConclusionMapping based on an NCP at the onset of the BiEGM and UniEGM and the least difference value of the earliest BiEGM and UniEGM dV/dTmax had an excellent predictive value for successful ablation. These strategies may reduce the number of radiofrequency catheter ablation (RFCA) applications for free‐wall tricuspid annular PVCs.

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“…The trabeculae are constant structures in the right ventricle in humans and animals while species and individual differences are observed in the left ventricle (Armiger et al, 1979; Gerlis et al, 1984; Ghonimi et al, 2014; Gulyaeva & Roshchevskaya, 2012; Haligur & Dursun, 2009; Truex & Warshaw, 1942). In various studies, it is stated that the structures containing conductive tissue may cause premature beats, arrhythmias (Barber et al, 2019; Lerman et al, 2018; Sadek et al, 2015) or innocent heart murmurs (Koie et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Morphology of septomarginal trabeculae in Hatay mountain gazelle (Gazella gazella)

Erdem

Tutar

Takçı

et al. 2021

Anat Histol Embryol

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This study was conducted to reveal the anatomical and histological features of left and right septomarginal trabeculae in the heart of the Hatay mountain gazelle. In the study, two female and two male adult Hatay mountain gazelle hearts were used. For this purpose, the materials detected in 10% formaldehyde solution were stained with Crossman's modified triple staining technique and examined under a light microscope after anatomical examinations and measurements were made. The presence of trabeculae in both ventricles was demonstrated. While the number of septomarginal trabeculae was 1 in each of the samples in the right ventricle, it was determined that it was 2 in each of three hearts and 3 in one heart in the left ventricle. It was observed that the right trabeculae were unbranched and fleshy, while the left trabeculae were filamentous and mostly branched. The lengths and thicknesses of the right trabeculae were measured 12–17 mm and 3–4 mm and the lengths and thicknesses of the left trabeculae were measured 6–15 mm and 0.5–1 mm. In the histological examination of both trabeculae, connective tissue, Purkinje fibres and blood vessels were observed, in addition, it was detected that the right trabeculae had myocardial fibres. Few capillaries were found in the left trabecula, while both more capillaries and blood vessels were found in the right trabeculae.

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Mechanistic subtypes of focal right ventricular tachycardia

Cited by 10 publications

References 41 publications

Electrophysiology and Arrhythmogenesis in the Human Right Ventricular Outflow Tract

Electrophysiology and Arrhythmogenesis in the Human Right Ventricular Outflow Tract

Unipolar and bipolar electrograms to predict successful ablation site of premature ventricular contractions originating from the free wall of the tricuspid annulus

Morphology of septomarginal trabeculae in Hatay mountain gazelle (Gazella gazella)

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