scholarly journals Idiopathic Outflow Tract Ventricular Arrhythmia Ablation: Pearls and Pitfalls

2019 ◽  
Vol 8 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Jackson J Liang ◽  
Yasuhiro Shirai ◽  
Aung Lin ◽  
Sanjay Dixit
Keyword(s):  
Ventricular Arrhythmias ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Structural Heart Disease ◽  
Careful Analysis ◽  
Intracardiac Echocardiography ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Successful Ablation ◽  
Pace Mapping

Idiopathic outflow tract ventricular arrhythmias (VAs) occur typically in patients without structural heart disease. They are often symptomatic and can sometimes lead to left ventricular systolic dysfunction. Both activation and pace mapping are utilised for successful ablation of these arrhythmias. Pace mapping is particularly helpful when the VA is infrequent and/or cannot be elucidated during the ablation procedure. VAs originating from different sites in the outflow tract region have distinct QRS patterns on the 12-lead ECG and careful analysis of the latter can help predict the site of origin of these arrhythmias. Successful ablation of these VAs requires understanding of the detailed anatomy of the OT region, which can be accomplished through electroanatomic mapping tools and intracardiac echocardiography.

Role of open access echocardiography in detection of cardiac structural and functional abnormalities

2022 ◽  
pp. postgradmedj-2021-141195
Author(s):  
Jason Chai ◽  
Hasan Mohiaddin ◽  
Amit K J Mandal ◽  
Jasmine Gan ◽  
Trisha Hirani ◽  
...  
Keyword(s):  
Open Access ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Aged Patients ◽  
Valvular Surgery ◽  
Cardiac Symptoms ◽  
Cardiac Valve Disease ◽  
Open Access Echocardiography

PurposeTo evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist.DesignData were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4–6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves.ResultsEchocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses.ConclusionMajor structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.

Electrocardiographic landmarks of idiopathic ventricular arrhythmia origins

Heart ◽  
2019 ◽  
Vol 105 (14) ◽  
pp. 1109-1116 ◽  
Author(s):  
Stylianos Tzeis ◽  
Dimitrios Asvestas ◽  
Siew Yen Ho ◽  
Panos Vardas
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Myocardial Scar ◽  
Mapping Tool ◽  
Surface Ecg

Idiopathic ventricular arrhythmias occur in the absence of underlying structural heart disease and less commonly in the presence of coexistent, but mechanistically unrelated, myocardial scar. These arrhythmias originate from several anatomical sites in both ventricles, with a predilection in outflow tract structures. The 12-lead surface ECG is the initial mapping tool, which is widely used to identify their origin. Specific features can predict the site of idiopathic ventricular arrhythmias, thus differentiating right from left ventricular, as well as endocardial from epicardial origins. In this review, we aim to analyse electrocardiographic landmarks for determination of idiopathic ventricular arrhythmia sources, with specific emphasis on pertinent caveats and anatomical relationships.

scholarly journals Left Atrial Function Is Improved in Short-Term Follow-Up after Catheter Ablation of Outflow Tract Premature Ventricular Complexes

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 241 ◽  
Author(s):  
Selçuk Kanat ◽  
Ferit Onur Mutluer ◽  
Ahmet Tütüncü ◽  
Bilge Duran Karaduman ◽  
Veciha Ozlem Bozkaya ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Left Atrial ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Short Term ◽  
Premature Ventricular Complexes ◽  
Diastolic Functions

Background: Association of premature ventricular complexes (PVC) with left ventricular systolic dysfunction (LVSD) and efficacy of catheter ablation treatment have been demonstrated in studies. The role of left atrial (LA) mechanics in the etiopathogenesis of PVC-induced cardiomyopathy (PVC-CMP) as well as changes in LA mechanics with catheter ablation have not been studied before. Methods: A total number of 61 patients (Mean Age 43 ± 3) with idiopathic outflow tract (OT) PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. ECG, 24 h Holter, and echocardiographic evaluation with left ventricular (LV) diastolic functions and LA volumetric assessments were performed before and three months after RFCA. Results: Along with a marginal increase in left ventricle ejection fraction (LVEF), improvement in diastolic functions and left atrial mechanics were observed in the study (LVEF 53 ± 7 versus 57 ± 6, p < 0.01) in short-term follow-up. The frequency of LV diastolic dysfunction (LVDD) decreased with catheter ablation (n = 5 to 0, p = 0.02). The overall LA function improved. Left atrium passive and overall emptying fraction (LAEF) increased significantly (0.32 ± 0.04 to 0.41 ± 0.04, p < 0.05 and 0.62 ± 0.04 to 0.65 ± 0.004, p < 0.05, respectively). Active LAEF decreased significantly (0.29 ± 0.005 to 0.24 ± 0.006, p < 0.05). Conclusions: The results of this study are indicative of “PVC-induced atriomyopathy” which responds to RFCA in short-term follow-up. Atrial dysfunction might play a role in symptoms and etiopathogenesis of LVSD.

scholarly journals Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

2021 ◽  
Vol 10 (1) ◽  
pp. 10-16
Author(s):  
Marco V Mariani ◽  
Agostino Piro ◽  
Domenico G Della Rocca ◽  
Giovanni B Forleo ◽  
Naga Venkata Pothineni ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Right Ventricular Outflow Tract ◽  
Structural Heart Disease ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Premature Ventricular Contractions ◽  
Left Ventricular Outflow ◽  
The Right ◽  
Ecg Criteria

Idiopathic ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. Of the ventricular arrhythmias (VAs) without underlying structural heart disease, those arising from the ventricular outflow tracts (OTs) are the most common. The right ventricular outflow tract (RVOT) is the most common site of origin for OT-VAs, but these arrhythmias can, less frequently, originate from the left ventricular outflow tract (LVOT). OT-VAs are focal and have characteristic ECG features based on their anatomical origin. Radiofrequency catheter ablation (RFCA) is an effective and safe treatment strategy for OT-VAs. Prediction of the OT-VA origin according to ECG features is an essential part of the preprocedural planning for RFCA procedures. Several ECG criteria have been proposed for differentiating OT site of origin. Unfortunately, the ECG features of RVOT-VAs and LVOT-VAs are similar and could possibly lead to misdiagnosis. The authors review the ECG criteria used in clinical practice to differentiate RVOT-VAs from LVOT-VAs.

Characteristics and outcomes of pace mapping for ablation of premature ventricular complexes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.J.B Kemme ◽  
R Ozer ◽  
M.J Mulder ◽  
H.A Hauer ◽  
G.J.M Tahapary ◽  
...  
Keyword(s):  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Mapping Technique ◽  
Premature Ventricular Complexes ◽  
Successful Ablation ◽  
Mapping System ◽  
Ablation Success ◽  
Pace Mapping ◽  
Activation Mapping

Abstract Background/Introduction Activation mapping is the “gold standard” for localisation of the site of origin during mapping and ablation of symptomatic premature ventricular complexes (PVC). In case of suppression of PVCs during the procedure, the origin of the PVC can be located using a pace mapping technique. The PASO module is an addition in the CARTO3 mapping system that calculates the correlation between the induced and observed 12-lead ECG PVC morphology, and visualises this correlation on an isochronal 3D colour map. Purpose The aim of this study was to compare the follow-up success rate of pace mapping using the PASO module and activation mapping and to determine cut-off values for clinical success. Methods Seventy-six consecutive ablation procedures of symptomatic PVCs were included in this single-center retrospective study. Mapping and ablation parameters were derived from the CARTO3 mapping system. Ablation success was defined as a ≥95% reduction in PVC burden on 24-hour Holter recordings or absence of the clinical PVC on multiple ECGs in case of multiple PVC morphologies. Logistic regression analysis was performed to evaluate the relationship between applied mapping methods and ablation parameters. Optimal cut-off values of ablation characteristics for successful ablation were determined using ROC curves. Results Thirty-five (46%) patients were male and 39 (51%) patients had a reduced left ventricular ejection fraction. Pace mapping was used in 36 (47%) patients. Baseline PVC burden was lower in patients when pace mapping was applied (18% vs. 28%, p&lt;0.001). The use of either mapping technique was influenced by PVC localisation (p=0.004). Pace mapping was used predominantly in the right ventricular outflow tract (n=21/31) whereas activation mapping was used predominantly in the left ventricle (n=14/22) and left ventricular outflow tract (n=7/7). Ablation success did not differ between activation mapping (77.5%) and pace mapping (77.8%). Median [IQR] maximum PASO correlation was 98.2% [97.1–98.6] for successful ablations and 96.5% [92.9–97.5] for unsuccessful ablations (p=0.030). The optimal cut-off value for successful ablation of the PASO correlation was 97.6% (AUC 0.754, sensitivity 68%, specificity 88%). There were no significant differences in other ablation parameters between both groups. Conclusion This study indicates that pace mapping using PASO is a good alternative for activation mapping for localisation of the PVC. A minimum PASO correlation coefficient of 97.6% is the optimal cut-off value for successful PVC ablation. ROC of maximum PASO coefficient Funding Acknowledgement Type of funding source: None

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