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Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways
Author(s) -
SZILI TOROK TAMAS,
DE VRIES LENNART J.,
ÖZCAN EMIN E.,
HASDEMIR CAN,
KIS ZSUZSANNA,
KARDOS ATTILA,
GÉCZY TAMAS,
KOVACS ISTVAN,
BENEDEK IMRE,
OOSTERWERFF ERIK,
HENDRIKS ASTRID A.,
KHAN MUCHTIAR,
YAP SINGCHIEN
Publication year - 2017
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.13098
Subject(s) - medicine , ablation , cardiology , ventricular outflow tract , bigeminy , catheter ablation , accessory pathway , outflow , ventricular tachycardia , physics , meteorology
Outflow Tract PVC Termination After AP Ablation Background Multiple mechanisms have been proposed for idiopathic premature ventricular contractions (PVCs) originating from the outflow tracts (OTs). Recent observations such as the coexistence of these arrhythmias with atrioventricular nodal reentrant tachycardias and the association between discrete prepotentials and successful ablation sites of ventricular arrhythmias (VAs) from the OTs suggest a common link. Objective In this case series we draw attention to a unique association between accessory pathways (APs) and idiopathic PVCs from the OTs, disappearing after AP ablation. Methods We identified 6 cases in collaboration with several international electrophysiology centers, which presented with pre‐excitation in association with OT, and in 1 case inflow tract (IT), PVCs on 12‐lead surface ECG. Results Six cases displayed pre‐excitation and PVCs, in 5 cases originating from the right ventricular outflow tract (RVOT) and in 1 case from the right ventricular inflow tract (RVIT). In all patients, PVCs were monomorphic and had fixed coupling intervals, in 3 cases presenting in bigeminy. Catheter ablation of the AP led to the simultaneous disappearance of PVCs in 5 of 6 cases. The sites of ablation were remote from the OTs in all these cases. In most cases, the occurrence of OT PVCs was closely associated with the presence of pre‐excitation. Conclusion The coexistence of pre‐excitation and PVCs from the OTs and the fact that in 5 of 6 cases PVCs disappeared after AP ablation suggests a common mechanism for arrhythmia genesis.