Ventricular arrhythmias originating from the aortomitral continuity: an uncommon variant of left ventricular outflow tract tachycardia

Abstract

We report a series of ventricular arrhythmias arising from the AMC with different R/S wave transition patterns in the precordial leads on the electrocardiogram. There may be a relationship between ventricular arrhythmias from AMC and AVNRT.

Optimal angulations for obtaining an en face view of each coronary aortic sinus and the interventricular septum: Correlative anatomy around the left ventricular outflow tract

“…The CASs and left ventricular outflow tract are major regions of interest for interventional cardiologists who perform percutaneous coronary intervention, radiofrequency catheter ablation (Kamakura et al, 1998;Daniels et al, 2006;Kumagai et al, 2008;Lin et al, 2008;Yamada et al, 2008a;Steven et al, 2009;Zhang et al, 2009;Yamada et al, 2010a;Yamada et al, 2010b;Letsas et al, 2011;Chen et al, 2012), and transcatheter aortic valve replacement (Cribier et al, 2002;Binder et al, 2012;Samim et al, 2013). The fluoroscopic definition of the anatomy around the left ventricular outflow tract is quite variable and a 3-D anatomical recognition within the cardiac contour seems difficult because of the morphological complexity of this area.…”

“…Many electrocardiographic characteristics that predict the origin of an arrhythmia have been reported to occur around this site (Kamakura et al, 1998;Daniels et al, 2006;Kumagai et al, 2008;Lin et al, 2008;Yamada et al, 2008a;Steven et al, 2009;Zhang et al, 2009;Yamada et al, 2010a;Yamada et al, 2010b;Letsas et al, 2011;Chen et al, 2012). Because approaches based on the QRS-wave morphology during an arrhythmia and endocardial or epicardial pacing are inductive, the correct recognition of the fluoroscopic anatomy for defining the exact site of the electrode position should be a fundamental practice.…”

“…However, each catheter laboratory has their preference of an image intensifier angulation (Farr e et al, 2002;Farr e et al, 2010) that may be adjusted conventionally for the interventricular septum (IVS). Furthermore, the fluoroscopic recognition and definition of the anatomy around the left ventricular outflow tract seems to vary between cases, especially around the left coronary aortic sinus (CAS), and between operators (Daniels et al, 2006;Kumagai et al, 2008;Lin et al, 2008;Yamada et al, 2008a;Steven et al, 2009;Zhang et al, 2009;Yamada et al, 2010a;Yamada et al, 2010b;Letsas et al, 2011;Chen et al, 2012), in part, due to the morphological complexity of the left ventricular outflow tract. As there have been few detailed studies on the optimal angulation for each CAS of Valsalva, this study aimed to revisit the basic fluoroscopic anatomy around the left ventricular outflow tract to determine the optimal angulations for accurately viewing the CASs and comparing them with those of the IVS by using multidetector-row computed tomography.…”

Electrophysiologic Characteristics of Ventricular Arrhythmias Arising From the Aortic Mitral Continuity – Potential Role of the Conduction System

“…Although successful ablation of arrhythmias at the AMC has been described, [1][2][3][4][5][6][7][8][9][10][11][12] the exact nature of the arrhythmogenic substrate remains unknown. 4,[13][14][15][16][17] While no myocardium has been found in this region, animal studies have shown that cells with electrophysiological properties similar to that of the atrioventricular (AV) junctional cells are present near the mitral annulus.…”

“…Although successful ablations of arrhythmias at the AMC have been reported in the literature, [1][2][3][4][5][6][7][8][9][10][11][12] knowledge of the clinical, electrocardiographic (ECG), and electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) arising from this region remains limited. Furthermore, being a fibrous structure, the exact nature of the arrhythmogenic substrate remains unclear.…”