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Utility of Distinctive Local Electrogram Pattern and Aortographic Anatomical Position in Catheter Manipulation at Coronary Cusps
Author(s) -
SASAKI TAKESHI,
HACHIYA HITOSHI,
HIRAO KENZO,
HIGUCHI KOJI,
HAYASHI TATSUYA,
FURUKAWA TOSHIYUKI,
KAWABATA MIHOKO,
TAKAHASHI ATSUSHI,
ISOBE MITSUAKI
Publication year - 2011
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2010.01957.x
Subject(s) - medicine , cardiology , position (finance) , catheter , radiology , economics , finance
Distinctive Electrogram and Aortography of Coronary Cusp . Background: The coronary cusps have recently become target sites for radiofrequency catheter ablation of both outflow tract ventricular arrhythmias originating near the coronary cusps (CC‐VA) and atrial tachyarrhythmias such as focal atrial tachycardia originating near the noncoronary cusp (NCC‐AT). However, the relation between local electrograms recorded at each CC during sinus rhythm and their anatomical position as assessed by aortography has not yet been systematically described. Methods and Results: In 28 patients undergoing RFCA for CC‐VA or NCC‐AT, amplitudes of the atrial and ventricular potentials at the CCs were measured during sinus rhythm, and the atrial/ventricular (A/V) potential ratio was computed. Relative positions of the CCs were assessed by aortography in 2 X‐ray projections. In the right (RCC) and left coronary cusps (LCC), amplitudes of the ventricular potential were larger than those of the atrial potential, leading to an A/V ratio <1 in all patients (0.08 ± 0.10, 0.32 ± 0.21, respectively). In contrast, in the NCC, the amplitude of the atrial potential was larger than the ventricular potential, leading to a higher A/V ratio relative to the CCs (5.7 ± 2.6, P < 0.0001). Aortography demonstrated the rightward and anterior location of the RCC, the leftward and superior location of the LCC, and the inferior and posterior location of the NCC. Conclusions: Awareness of the distinctive local electrogram pattern of each CC and their positions on aortography should lead to safer and more effective catheter ablation at the CCs. (J Cardiovasc Electrophysiol, Vol. 22, pp. 521‐529 May 2011)