Repetitive Monomorphic Ventricular Tachycardia of Left Coronary Cusp Origin

Abstract

Repetitive monomorphic ventricular tachycardia with a morphology of inferior axis and left bundle branch block pattern in patients without structural heart disease commonly originates from the right ventricular outflow tract. We report the case of a 22-year-old man with an incessant, monomorphic ventricular tachycardia with a similar morphology originating from the left coronary cusp, which was confirmed by perfect pace mapping, local ventricular activation preceding the onset of QRS by 25 mse, and eliminated by a single delivery of low-energy (11 W) radiofrequency currents.

Electrophysiological Characteristics of Idiopathic Ventricular Tachycardia in Children

“…11 LVOT tachycardia can arise from endocardial sites, epicardial sites, 12 the area of the aorto-mitral continuity, as well as from foci accessible from the aortic sinuses of Valsalva. 13, 14 In our study, 56% of the idiopathic VT originated from the RV, and 95% of those originated from the RVOT. In 2 of 4 patients with a LVOT origin, the VT originated from epicardial sites.…”

“…Organic heart disease was excluded by physical examination, chest radiography, and echocardiography. The 46 children (18 males, 28 females) with a mean age of 11.7± 3.4 years (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) were included in this study. Their mean body weight was 41.6±14.2 kg (17.9-71.6 kg), mean body length 147.1±18.3 cm (109.4-178.0 cm), and mean body surface area 1.30±0.30 m 2 (0.74-1.85 m 2 ).…”

Novel algorithm for arrhythmogenic focus localization in patients with right ventricular outflow tract arrhythmias

“…Among a large group of arrhythmias with ECG bundle branch block pattern, those originating in RVOT can be the target for catheter ablation with procedure effectiveness of 90-95% [2,[13][14][15][16]. Arrhythmogenic focus in RVOT is located in the majority of patients on the anterior or antero-lateral wall of sub-pulmonary valve right ventricular region [8,15].…”

Left Ventricular Epicardial Outflow Tract Tachycardia

“…In fact, in 3 of 7 patients in the present study, the Q-wave amplitude in aVL was smaller than that of aVR, suggesting that comparing the Q-wave amplitudes in these 2 leads does not help to identify cases of LV-epi VT that could be ablated from the LSV. All of these ECG findings were observed in patient 4 and in other patients with similar VT. [6][7][8] Therefore, a relatively high amplitude R-wave in V1, a deep S-wave in V2, and a high amplitude R-wave and shallow S-wave in V3, as well as high amplitude R-waves in the inferior leads, may identify LV-epi VT that could be ablated from the LSV.…”

“…It is important to localize the VT origin precisely in the LVOT epicardium because some LV-epi VT can be ablated from the LSV, [6][7][8] or from the main pulmonary artery 9 or GCV-AIV. 3 In 3 of the present patients (patients 1-3) with LV-epi VT, the origin of the VT was close to the proximal AIV, and in particular, the origin in patient 3 was in the more distal portion of the AIV compared with the other 2 patients.…”