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Article: Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity - Potential role of the conduction system

TitleElectrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity - Potential role of the conduction system
Authors
Keywordsventricular arrhythmias
aortomitral continuity
arrhythmogenic substrate
conduction system
Issue Date2015
Citation
Journal of Cardiovascular Electrophysiology, 2015, v. 26, n. 2, p. 158-163 How to Cite?
Abstract© 2014 Wiley Periodicals, Inc. 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, R2 = 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.
Persistent Identifierhttp://hdl.handle.net/10722/213451
ISSN
2015 Impact Factor: 3.097
2015 SCImago Journal Rankings: 1.863
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorHai, Jo Jo-
dc.contributor.authorChahal, Anwar A.-
dc.contributor.authorFriedman, Paul A.-
dc.contributor.authorVaidya, Vaibhav R.-
dc.contributor.authorSyed, Faisal F.-
dc.contributor.authorDesimone, Christopher V.-
dc.contributor.authorNanda, Sudip-
dc.contributor.authorBrady, Peter A.-
dc.contributor.authorMadhavan, Malini-
dc.contributor.authorCha, Yong Mei-
dc.contributor.authorMcLeod, Christopher J.-
dc.contributor.authorMulpuru, Siva-
dc.contributor.authorMunger, Thomas M.-
dc.contributor.authorPacker, Douglas L.-
dc.contributor.authorAsirvatham, Samuel J.-
dc.date.accessioned2015-07-28T04:07:20Z-
dc.date.available2015-07-28T04:07:20Z-
dc.date.issued2015-
dc.identifier.citationJournal of Cardiovascular Electrophysiology, 2015, v. 26, n. 2, p. 158-163-
dc.identifier.issn1045-3873-
dc.identifier.urihttp://hdl.handle.net/10722/213451-
dc.description.abstract© 2014 Wiley Periodicals, Inc. 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, R2 = 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.-
dc.languageeng-
dc.relation.ispartofJournal of Cardiovascular Electrophysiology-
dc.subjectventricular arrhythmias-
dc.subjectaortomitral continuity-
dc.subjectarrhythmogenic substrate-
dc.subjectconduction system-
dc.titleElectrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity - Potential role of the conduction system-
dc.typeArticle-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1111/jce.12587-
dc.identifier.pmcidPMC4454447-
dc.identifier.scopuseid_2-s2.0-84922447803-
dc.identifier.hkuros269580-
dc.identifier.volume26-
dc.identifier.issue2-
dc.identifier.spage158-
dc.identifier.epage163-
dc.identifier.eissn1540-8167-

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