Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity

Tatsuya Hayashi, Pasquale Santangeli, Rajeev K. Pathak, Daniele Muser, Jackson J. Liang, Simon A. Castro, Fermin C. Garcia, Mathew D. Hutchinson, Gregory E. Supple, David S. Frankel, Michael P. Riley, David Lin, Robert D. Schaller, Sanjay Dixit, David J. Callans, Erica S. Zado, Francis E. Marchlinski

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction: In outflow tract ventricular arrhythmias (OT-VAs), an abrupt loss of the R wave in lead V2 compared to V1 and V3 (pattern break in V2–PBV2) suggests an origin close to the anterior interventricular sulcus (anatomically opposite to lead V2) and adjacent to proximal coronaries. We studied the outcome of catheter ablation of OT-VAs with a PBV2. Methods and Results: Of 130 consecutive patients with idiopathic left bundle block morphology OT-VAs and transition ≤V4, 12 (9%) had PBV2. Outcomes in this group were compared to the remaining 118 patients. Patients with PBV2 were more likely to be younger (41 ± 18 vs. 50 ± 14 years, P = 0.0384) and women (11 [92%] vs. 70 [59%], P = 0.0302). The earliest activation was at the RVOT in seven, left coronary cusp (LCC) in one, anterior interventricular vein (AIV) in two and the epicardium in two. In five (42%) cases (earliest activation in the AIV in two, epicardium in two, and RVOT below the valve level in one), ablation was aborted due to proximity to the left anterior descending (LAD) coronary artery. After 36 ± 17 months and 1.3 ± 0.5 procedures, VAs elimination was achieved in 58% of patients with PBV2 compared to 89% of the reference population (P = 0.0125) with effective site in five of seven at the most anterior and leftward RVOT adjacent to the pulmonic valve (PV). Conclusions: OT-VAs with PBV2 demonstrate a unique ECG pattern and challenging catheter ablation. Proximity to LAD precludes ablation in about half. Long-term VA suppression could be achieved in only 58% of cases most commonly when the earliest site is at the anterior and leftward RVOT just under the PV.

LanguageEnglish
Pages504-514
Number of pages11
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • anterior interventricular sulcus
  • catheter ablation
  • epicardial ablation
  • outflow tract arrhythmias
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hayashi, Tatsuya ; Santangeli, Pasquale ; Pathak, Rajeev K. ; Muser, Daniele ; Liang, Jackson J. ; Castro, Simon A. ; Garcia, Fermin C. ; Hutchinson, Mathew D. ; Supple, Gregory E. ; Frankel, David S. ; Riley, Michael P. ; Lin, David ; Schaller, Robert D. ; Dixit, Sanjay ; Callans, David J. ; Zado, Erica S. ; Marchlinski, Francis E. / Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2 : A Distinct Clinical Entity. In: Journal of Cardiovascular Electrophysiology. 2017 ; Vol. 28, No. 5. pp. 504-514.
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title = "Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity",
abstract = "Introduction: In outflow tract ventricular arrhythmias (OT-VAs), an abrupt loss of the R wave in lead V2 compared to V1 and V3 (pattern break in V2–PBV2) suggests an origin close to the anterior interventricular sulcus (anatomically opposite to lead V2) and adjacent to proximal coronaries. We studied the outcome of catheter ablation of OT-VAs with a PBV2. Methods and Results: Of 130 consecutive patients with idiopathic left bundle block morphology OT-VAs and transition ≤V4, 12 (9{\%}) had PBV2. Outcomes in this group were compared to the remaining 118 patients. Patients with PBV2 were more likely to be younger (41 ± 18 vs. 50 ± 14 years, P = 0.0384) and women (11 [92{\%}] vs. 70 [59{\%}], P = 0.0302). The earliest activation was at the RVOT in seven, left coronary cusp (LCC) in one, anterior interventricular vein (AIV) in two and the epicardium in two. In five (42{\%}) cases (earliest activation in the AIV in two, epicardium in two, and RVOT below the valve level in one), ablation was aborted due to proximity to the left anterior descending (LAD) coronary artery. After 36 ± 17 months and 1.3 ± 0.5 procedures, VAs elimination was achieved in 58{\%} of patients with PBV2 compared to 89{\%} of the reference population (P = 0.0125) with effective site in five of seven at the most anterior and leftward RVOT adjacent to the pulmonic valve (PV). Conclusions: OT-VAs with PBV2 demonstrate a unique ECG pattern and challenging catheter ablation. Proximity to LAD precludes ablation in about half. Long-term VA suppression could be achieved in only 58{\%} of cases most commonly when the earliest site is at the anterior and leftward RVOT just under the PV.",
keywords = "anterior interventricular sulcus, catheter ablation, epicardial ablation, outflow tract arrhythmias, ventricular tachycardia",
author = "Tatsuya Hayashi and Pasquale Santangeli and Pathak, {Rajeev K.} and Daniele Muser and Liang, {Jackson J.} and Castro, {Simon A.} and Garcia, {Fermin C.} and Hutchinson, {Mathew D.} and Supple, {Gregory E.} and Frankel, {David S.} and Riley, {Michael P.} and David Lin and Schaller, {Robert D.} and Sanjay Dixit and Callans, {David J.} and Zado, {Erica S.} and Marchlinski, {Francis E.}",
year = "2017",
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pages = "504--514",
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Hayashi, T, Santangeli, P, Pathak, RK, Muser, D, Liang, JJ, Castro, SA, Garcia, FC, Hutchinson, MD, Supple, GE, Frankel, DS, Riley, MP, Lin, D, Schaller, RD, Dixit, S, Callans, DJ, Zado, ES & Marchlinski, FE 2017, 'Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity', Journal of Cardiovascular Electrophysiology, vol. 28, no. 5, pp. 504-514. https://doi.org/10.1111/jce.13183

Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2 : A Distinct Clinical Entity. / Hayashi, Tatsuya; Santangeli, Pasquale; Pathak, Rajeev K.; Muser, Daniele; Liang, Jackson J.; Castro, Simon A.; Garcia, Fermin C.; Hutchinson, Mathew D.; Supple, Gregory E.; Frankel, David S.; Riley, Michael P.; Lin, David; Schaller, Robert D.; Dixit, Sanjay; Callans, David J.; Zado, Erica S.; Marchlinski, Francis E.

In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 5, 01.05.2017, p. 504-514.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2

T2 - Journal of Cardiovascular Electrophysiology

AU - Hayashi, Tatsuya

AU - Santangeli, Pasquale

AU - Pathak, Rajeev K.

AU - Muser, Daniele

AU - Liang, Jackson J.

AU - Castro, Simon A.

AU - Garcia, Fermin C.

AU - Hutchinson, Mathew D.

AU - Supple, Gregory E.

AU - Frankel, David S.

AU - Riley, Michael P.

AU - Lin, David

AU - Schaller, Robert D.

AU - Dixit, Sanjay

AU - Callans, David J.

AU - Zado, Erica S.

AU - Marchlinski, Francis E.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Introduction: In outflow tract ventricular arrhythmias (OT-VAs), an abrupt loss of the R wave in lead V2 compared to V1 and V3 (pattern break in V2–PBV2) suggests an origin close to the anterior interventricular sulcus (anatomically opposite to lead V2) and adjacent to proximal coronaries. We studied the outcome of catheter ablation of OT-VAs with a PBV2. Methods and Results: Of 130 consecutive patients with idiopathic left bundle block morphology OT-VAs and transition ≤V4, 12 (9%) had PBV2. Outcomes in this group were compared to the remaining 118 patients. Patients with PBV2 were more likely to be younger (41 ± 18 vs. 50 ± 14 years, P = 0.0384) and women (11 [92%] vs. 70 [59%], P = 0.0302). The earliest activation was at the RVOT in seven, left coronary cusp (LCC) in one, anterior interventricular vein (AIV) in two and the epicardium in two. In five (42%) cases (earliest activation in the AIV in two, epicardium in two, and RVOT below the valve level in one), ablation was aborted due to proximity to the left anterior descending (LAD) coronary artery. After 36 ± 17 months and 1.3 ± 0.5 procedures, VAs elimination was achieved in 58% of patients with PBV2 compared to 89% of the reference population (P = 0.0125) with effective site in five of seven at the most anterior and leftward RVOT adjacent to the pulmonic valve (PV). Conclusions: OT-VAs with PBV2 demonstrate a unique ECG pattern and challenging catheter ablation. Proximity to LAD precludes ablation in about half. Long-term VA suppression could be achieved in only 58% of cases most commonly when the earliest site is at the anterior and leftward RVOT just under the PV.

AB - Introduction: In outflow tract ventricular arrhythmias (OT-VAs), an abrupt loss of the R wave in lead V2 compared to V1 and V3 (pattern break in V2–PBV2) suggests an origin close to the anterior interventricular sulcus (anatomically opposite to lead V2) and adjacent to proximal coronaries. We studied the outcome of catheter ablation of OT-VAs with a PBV2. Methods and Results: Of 130 consecutive patients with idiopathic left bundle block morphology OT-VAs and transition ≤V4, 12 (9%) had PBV2. Outcomes in this group were compared to the remaining 118 patients. Patients with PBV2 were more likely to be younger (41 ± 18 vs. 50 ± 14 years, P = 0.0384) and women (11 [92%] vs. 70 [59%], P = 0.0302). The earliest activation was at the RVOT in seven, left coronary cusp (LCC) in one, anterior interventricular vein (AIV) in two and the epicardium in two. In five (42%) cases (earliest activation in the AIV in two, epicardium in two, and RVOT below the valve level in one), ablation was aborted due to proximity to the left anterior descending (LAD) coronary artery. After 36 ± 17 months and 1.3 ± 0.5 procedures, VAs elimination was achieved in 58% of patients with PBV2 compared to 89% of the reference population (P = 0.0125) with effective site in five of seven at the most anterior and leftward RVOT adjacent to the pulmonic valve (PV). Conclusions: OT-VAs with PBV2 demonstrate a unique ECG pattern and challenging catheter ablation. Proximity to LAD precludes ablation in about half. Long-term VA suppression could be achieved in only 58% of cases most commonly when the earliest site is at the anterior and leftward RVOT just under the PV.

KW - anterior interventricular sulcus

KW - catheter ablation

KW - epicardial ablation

KW - outflow tract arrhythmias

KW - ventricular tachycardia

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U2 - 10.1111/jce.13183

DO - 10.1111/jce.13183

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JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

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