Surface electrocardiography characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left infero-septal papillary muscles: differences from those originating from the left posterior fascicle

Li, Shixing; Wang, Zulu; Shan, Zhaoliang; Shi, Xiaorui; Liang, Ming; Jin, Zhiqing; Han, Yaling; Wang, Yutang

doi:10.1093/europace/eux071

Cited by 14 publications

(32 citation statements)

References 15 publications

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“…However, the ECG features are very similar for PAM and LV fascicular PVCs, and an R/S ratio ≤1 in lead V6 in the LV anterolateral region and a QRS duration >160 ms, and qR or R waves in lead V1 (as compared with an rsR’ for fascicular PVCs) in the LV posteroseptal region may be the only reliable predictors for differentiating PAM PVCs from LV fascicular PVCs . A QRS duration of less than 130 ms strongly suggests fascicular PVCs in both the LV anterolateral and posteroseptal regions …”

Section: Specific Considerationmentioning

confidence: 93%

“…An rS in lead aVL and absence of a positive precordial concordance pattern or R/S ratio ≤1 in lead V6 can do so for only inferior QRS axis PVCs originating from the LV anterolateral region or superior QRS axis PVCs originating from the posterior region, respectively . However, the ECG features are very similar for PAM and LV fascicular PVCs, and an R/S ratio ≤1 in lead V6 in the LV anterolateral region and a QRS duration >160 ms, and qR or R waves in lead V1 (as compared with an rsR’ for fascicular PVCs) in the LV posteroseptal region may be the only reliable predictors for differentiating PAM PVCs from LV fascicular PVCs . A QRS duration of less than 130 ms strongly suggests fascicular PVCs in both the LV anterolateral and posteroseptal regions …”

Section: Specific Considerationmentioning

confidence: 97%

“…A lot of ECG algorithms for predicting the location of an idiopathic PVC origin have been proposed. [6][7][8][16][17][18][20][21][22]24,26,30,41,42,45,[53][54][55]60 However, most of them were developed to differentiate sites of PVC origins in a specific region such as the ventricular outflow tract, right ventricular His bundle region, and so forth, and they can be less accurate or cannot be used in an ECG diagnosis of overall idiopathic…”

Section: Ecg Algorithmsmentioning

confidence: 99%

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Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

Yamada

2019

Cardiovasc electrophysiol

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The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve‐lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients’ physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12‐lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.

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Section: Specific Considerationmentioning

confidence: 93%

Section: Specific Considerationmentioning

confidence: 97%

Section: Ecg Algorithmsmentioning

confidence: 99%

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Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

Yamada

2019

Cardiovasc electrophysiol

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“…PMs are complex anatomical structures of variable size and geometry. Previous studies on ablation of PMs related ectopy identified the problems associated with ablation procedure in detail. They described difficulty obtaining stable catheter‐tissue contact because of high mobility of PMs and limited efficacy of pace mapping.…”

Section: Introductionmentioning

confidence: 99%

“…PMs are complex anatomical structures of variable size and geometry. Previous studies on ablation of PMs related ectopy [4][5][6][7][8][9][10][11][12][13] identified the problems associated with ablation procedure in detail.…”

Section: Introductionmentioning

confidence: 99%

The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle

Peichl

Wichterle

Čihák

et al. 2017

Cardiovasc electrophysiol

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Introduction: Frequent ventricular premature complexes (VPCs) may cause symptoms and/or lead to deterioration of LV systolic function. Although frequent VPCs may be abolished by catheter ablation, it may be challenging in case of their origin from the LV papillary muscles (PMs). Our collaborative study aimed to analyze in detail the site of origin and the outcome of ablation. Methods:Consecutive 34 patients (males: 68%; aged 62 ± 12 years; LV ejection fraction: 50 ± 9%) undergoing catheter ablation of VPCs originating from PMs were included. All procedures were guided by intracardiac echocardiography. Results:The size and shape of PMs were highly variable. The length of anterolateral and posteromedial PM was 23 ± 4 mm and 28 ± 7 mm, respectively. In about one-third of patients, the PM was formed by two distinctly separate heads. The ectopic foci were located on anterolateral, posteromedial or both PM in 35%, 56% and 9% of cases, respectively. Their location was found within the distal, mid, or proximal (basal) third of PM in the 67%, 19%, and 14%, respectively. A total of 86% of PM foci were acutely abolished and long-term success was achieved in 65% of patients. Absence of VPCs of other morphologies and a high burden of ectopic activity before ablation were associated with favorable clinical outcome. Conclusion:VPCs originate predominantly from the distal portion of the PM. This knowledge may facilitate the mapping in patients with infrequent ectopic beats. Intracardiac echocardiography is of crucial importance for navigation of the ablation catheter and for assessment of its stability at PM target sites.

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Remote magnetic‐guided ablation for three origins of idiopathic ventricular arrhythmias with right bundle branch block and superior axis

Wen-tao²,

Zhang

et al. 2021

Clinical Cardiology

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Background Idiopathic ventricular arrhythmias (IVAs) with right bundle branch block (RBBB) and superior axis commonly originate from posterior mitral annulus (PMA), the left ventricular (LV) posterior fascicle (LPF), and the LV posterior papillary muscles (PPM). Hypothesis Remote magnetic navigation (RMN)‐guided ablation might be safe and effective for these three origins of IVAs. Methods Thirty consecutive IVA patients with RBBB and superior axis (11 MPA‐IVAs, 11 LPF‐IVAs, and 8 PPM‐IVAs) were included in this study. Electrical mapping and ablation with RMN were performed in the LV through a trans‐septal approach. Navigation index, defined as the ratio of total radiofrequency (RF) time and the time from first burn to last burn, was used to determine the efficiency of RMN‐guided ablation. Results The overall acute success rate was achieved in 93% (PMA, 100%; LPF, 91%; PPM, 88%; p > 0.05). No complication occurred in this study. The procedure time of PPM‐IVAs group was 34 and 14 min longer when compared with MPA‐IVAs and LPF‐IVAs group, respectively, without an increase of X‐ray time. The mean navigation index was 0.45 ± 0.20. The PPM‐IVAs group had an underperforming navigation index value (0.29 ± 0.11) (p < 0.01), as longer RF time was required in the PPM‐IVAs group. Conclusions RMN‐guided ablation can achieve a high acute success rate for IVAs with RBBB and superior axis. The lower navigation index for PPM‐IVAs indicated that increasing the RF time and improving the catheter contact should be considered when using RMN.

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Surface electrocardiography characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left infero-septal papillary muscles: differences from those originating from the left posterior fascicle

Abstract: PM ventricular arrhythmias could be identified from LPF ventricular arrhythmias by calculation of QRS duration combined with Vi/Vt using ECG.

Cited by 14 publications

References 15 publications

Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle

Remote magnetic‐guided ablation for three origins of idiopathic ventricular arrhythmias with right bundle branch block and superior axis

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