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Idiopathic basal crux ventricular arrhythmias with left bundle branch block and superior axis: A comparison with inferior‐septal valvular arrhythmias
Author(s) -
Kawamura Mitsuharu,
Arai Shuhei,
Gokan Toshihiko,
Yoshikawa Kosuke,
Ogawa Ko,
Ochi Akinori,
Chiba Yuta,
Onishi Yoshimi,
Munetsugu Yumi,
Ito Hiroyuki,
Onuki Tatsuya,
Kobayashi Youichi,
Shinke Toshiro
Publication year - 2019
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.14103
Subject(s) - medicine , left bundle branch block , cardiology , basal (medicine) , ejection fraction , coronary sinus , electrocardiography , electrophysiology study , catheter ablation , ablation , heart failure , insulin
Left bundle branch block (LBBB) with superior axis is common in patients with idiopathic‐ventricular arrhythmia (VA) originating from the tricuspid annulus (TA) and rarely from the cardiac basal crux and mitral annulus (MA). We described the electrocardiography and electrophysiological findings of idiopathic‐VA presenting with LBBB and superior axis. Methods and Results We described 42 idiopathic‐VA patients who had an LBBB and superior axis; 15 basal crux‐VA, 17 TA‐VA, and 10 MA‐VA. No patient had a structural heart disease. Among patients with idiopathic‐VA referred for ablation, we investigated the electrocardiogram and clinical characteristics of basal crux‐VA as compared with other LBBB and superior axis‐VA. The left ventricular ejection fraction with MA‐VA was significantly lower in comparison with basal crux‐VA ( P = .01). All patients had a positive R wave in lead I and aVL. The maximum deflection index with basal crux‐VA was significantly higher in comparison with TA‐VA or MA‐VA ( P = .01). Patients with basal crux‐VA presented with QS wave in lead II more frequently as compared with TA‐VA or MA‐VA ( P = .001). All MA‐VA patients had Rs wave in V6, and basal crux‐VA, and TA‐VA patients had a monophasic R wave or Rs wave in V6. Basal crux‐VA patients underwent ablation in the middle cardiac vein (MCV) or coronary sinus (success rate: 94%, recurrence rate: 6%). Conclusions We could distinguish basal crux‐VA, TA‐VA, and MA‐VA, using a combination of clinical and electrocardiographic findings. These findings might be useful for counseling patients about an ablation strategy. Ablation via the MCV is effective for eliminating basal crux‐VA.