Ventricular tachycardia originating from the posteroseptal process of the left ventricle with inferior wall healed myocardial infarction

Lacroix, Dominique; Klug, Didier; Grandmougin, Daniel; Jarwe, Mustapha; Kouakam, Claude; Kacet, Salem

doi:10.1016/s0002-9149(99)00231-3

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…Consistent with our findings, previous studies have also found that VA originating from basal inferior LV was characterized by Q waves in inferior leads. 19 Lacroix et al 21 described that ischemic VT originating from posteroseptal LV had a left superior axis with positive QRS morphology in V2, with various QRS morphology in V1. We speculate the mechanisms that the QRS morphology could change abruptly from RBBB to LBBB pattern in the apical crux area.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Idiopathic Ventricular Arrhythmia Originating From the Cardiac Crux or Inferior Septum

Kawamura

Gerstenfeld

Vedantham

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Idiopathic ventricular arrhythmia (VA) can arise from the epicardium near the posteroseptal region (cardiac crux). There are only 2 prior reports describing idiopathic VA from the cardiac crux. The purpose of this study was to characterize the clinical and the electrocardiographic features of idiopathic crux VA. Methods and Results-Crux VA was identified in 18 patients undergoing catheter ablation. We divided patients into 2 groups, those with VA originating from the apical crux (n=9) and the basal crux (n=9). We described the clinical and electrocardiographic characteristics of crux VA as well as the ablation results. Furthermore, we compared clinical features of crux VA with other sites of idiopathic VA. Fifteen crux VA patients (83%) had sustained ventricular tachycardia and 3 patients required implantable cardioverter defibrillator implantation because of syncope. All patients had a left superior axis and 16 patients had R>S wave in V2. In apical crux VA, all patients had a deep S wave in V6 and 8 patients (89%) had R>S wave in aVR. All apical crux patients underwent attempted ablation in the middle cardiac vein without success. In 4 of these patients, epicardial ablation with subxiphoid approach was performed successfully. All basal crux VA patients had either negative or isoelectric pattern in V1 and had R>S in V6. Patients had successful ablation within the middle cardiac vein. Conclusions-Apical versus basal crux VA is identified as a new category of idiopathic VA with distinctive electrocardiographic characteristics; ablation via the middle cardiac vein is effective for eliminating basal crux VA, whereas apical crux VA often requires a subxiphoid epicardial approach. (Circ Arrhythm Electrophysiol. 2014;7:1152-1158.)

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Idiopathic Ventricular Arrhythmia Originating From the Cardiac Crux or Inferior Septum

Kawamura

Gerstenfeld

Vedantham

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…2 ,3 More recently, a distinct type of VT originating from the posteroseptal process of the left ventricle has been described in patients after inferior wall MI. 4 Due to early epicardial activation at the level of the crux of the heart, such VT presents with characteristic ECG morphology resembling excitation through a posteroseptal accessory pathway. Importantly, this type of VT was shown to be curable surgically by left septal and epicardial cryolesions.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, this type of VT was shown to be curable surgically by left septal and epicardial cryolesions. 4 In this report, we present a case of recurrent monomorphic postinfarction VT suggestive of posteroseptal origin in which radiofrequency (RF) catheter ablation was accomplished successfully from the proximal coronary sinus.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia from the Proximal Coronary Sinus

Kautzner

Bytešník

Čihák

et al. 2001

Cardiovasc electrophysiol

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Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57-year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible.

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“…The infarct location and transmural extent influence the incidence of epicardial VTs. They are more common in inferior infarction compared to other locations [7, 8, 31]. The presence of epicardial circuits has been recognized as a cause of recurrence after endocardial VT ablation [32].…”

Section: Ventricular Tachycardia After Myocardial Infarctionmentioning

confidence: 99%

How to Recognize Epicardial Origin of Ventricular Tachycardias?

Fernández-Armenta¹,

Berruezo

2014

CCR

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Percutaneous pericardial access for epicardial mapping and ablation of ventricular arrhythmias has expanded considerably in recent years. After its description in patients with Chagas disease, the technique has provided relevant in-formation on the arrhythmia substrate in other cardiomyopathies and has improved the results of ablation procedures in various clinical settings. Electrocardiographic criteria proposed for the recognition of the epicardial origin of ventricular tachycardias are mainly based on analysis of the first QRS components. Ventricular activation at the epicardium has a slow initial component reflecting the transmural activation and influenced by the absence of Purkinje system in the epicardium. Various parameters (pseudodelta wave, intrinsicoid deflection and shortest RS interval) of these initial intervals predict an epicardial origin in patients with scar-related ventricular tachycardias with right bundle branch block morphology. Using the same concept, the maximum deflection index was defined for the location of idiopathic epicardial tachycardias remote from the aortic root. Electrocardiogram criteria based on the morphology of the first component of the QRS (q wave in lead I) have been proposed in patients with nonischemic cardiomyopathy. All these criteria seem to be substrate-specific and have several limitations. Other information, including type of underlying heart disease, previous failed endocardial ablation, and evidence of epicardial scar on magnetic resonance imaging, can help to plan the ablation procedure and decide on an epicardial approach.

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Ventricular tachycardia originating from the posteroseptal process of the left ventricle with inferior wall healed myocardial infarction

Cited by 13 publications

References 21 publications

Idiopathic Ventricular Arrhythmia Originating From the Cardiac Crux or Inferior Septum

Idiopathic Ventricular Arrhythmia Originating From the Cardiac Crux or Inferior Septum

Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia from the Proximal Coronary Sinus

How to Recognize Epicardial Origin of Ventricular Tachycardias?

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