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Electrophysiologic Characteristics of Ventricular Arrhythmias Arising from the Aortic Mitral Continuity—Potential Role of the Conduction System
Author(s) -
HAI JO JO,
CHAHAL ANWAR A.,
FRIEDMAN PAUL A.,
VAIDYA VAIBHAV R.,
SYED FAISAL F.,
DeSIMONE CHRISTOPHER V.,
NANDA SUDIP,
BRADY PETER A.,
MADHAVAN MALINI,
CHA YONGMEI,
McLEOD CHRISTOPHER J.,
MULPURU SIVA,
MUNGER THOMAS M.,
PACKER DOUGLAS L.,
ASIRVATHAM SAMUEL J.
Publication year - 2015
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/jce.12587
Subject(s) - medicine , cardiology , ablation , qrs complex , catheter ablation , sinus rhythm , aortic sinus , electrical conduction system of the heart , electrocardiography , atrial fibrillation , aorta
Arrhythmogenic Substrate of Ventricular Arrhythmias at the AMC Introduction Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown. Methods Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate. Results Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs; 26.1 ± 10.9% vs. 14.9 ± 10.1%, P = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 milliseconds vs. 33.1 ± 8.8 milliseconds, P = 0.03), lower pace map scores (8.7 ± 1.6 vs. 11.4 ± 0.8, P = 0.001), and a trend toward shorter V‐H intervals during VA (32.1 ± 38.6 milliseconds vs. 76.3 ± 11.1 milliseconds, P = 0.06) as compared to those without PP. A strong and positive correlation was found between V‐H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R 2 = 0.97, t = 13.7, P < 0.001) but not in those without PPs. Conclusion Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success.