Clinical, electrocardiographic and electrophysiological characteristics, and catheter ablation results of left upper septal premature ventricular complexes.
fascicular potential
left fascicular system
left upper septal
premature ventricular complex
radiofrequency catheter ablation
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
07
07
2020
revised:
20
09
2020
accepted:
28
09
2020
pubmed:
4
10
2020
medline:
29
7
2021
entrez:
3
10
2020
Statut:
ppublish
Résumé
To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system. Thirty-one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping. The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential-ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His-ventricular (H-V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H-V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow-up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow-up duration of 24.3 ± 15.4 months. LUS-PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.
Sections du résumé
BACKGROUND
To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system.
METHODS
Thirty-one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping.
RESULTS
The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential-ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His-ventricular (H-V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H-V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow-up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow-up duration of 24.3 ± 15.4 months.
CONCLUSIONS
LUS-PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3251-3261Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Nogami A. Purkinje-related arrhythmias part I: monomorphic ventricular tachycardias. Pacing Clin Electrophysiol. 2011;34:624-650.
Guo XG, Liu X, Zhou GB, et al. Clinical, electrocardiographic, and electrophysiological characteristics of left upper septal fascicular ventricular tachycardia. Europace. 2018;20:673-681.
Wang Y-F, Xu Q, Luo H, Yu J-W, Qu B-M, Wang L-H. Catheter ablation of premature ventricular contractions arising from left anterior fascicle guided by an earliest presystolic Purkinje potential. Int J Cardiol. 221, 2016:280-282.
Pathak RK, Betensky BP, Santangeli P, Dixit S. Distinct electrocardiographic form of idiopathic ventricular arrhythmia originating from the left bundle branch. J Cardiovasc Electrophysiol. 2017;28:115-119.
Zhang J, Tang C, Zhang Y, Su X. Catheter ablation of premature ventricular complexes arising from the left fascicular system. Heart Rhythm. 2019;16:527-535.
Gordon JP, Liang JJ, Pathak RK, et al. Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 2018;29:1654-1663.
Edward JA, Zipse MM, Tompkins C, et al. Follow-up after catheter ablation of papillary muscles and valve cusps. JACC Clin Electrophysiol. 2019;5:1185-1196.
Enriquez A, Shirai Y, Huang J, et al. Papillary muscle ventricular arrhythmias in patients with arrhythmic mitral valve prolapse: electrophysiologic substrate and catheter ablation outcomes. J Cardiovasc Electrophysiol. 2019;30:827-835.
Nakagawa H, Beckman KJ, McClelland JH, et al. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation. 1993;88:2607-2617.
Chen H, Zhang F, Yang B, et al. A novel method to identify the origin of ventricular tachycardia from the left fascicular system. Heart Rhythm. 2016;13:686-694.
Kulbertus HE. Concept of left hemiblocks revisited. A histopathological and experimental study. Adv Cardiol. 1975;14:126-135.
Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks revisited. Circulation. 2007;115:1154-1163.
Chen S, Lu X, Peng S, et al. Ablation at right coronary cusp as an alternative and favorable approach to eliminate premature ventricular complexes originating from the proximal left anterior fascicle. Circ Arrhythm Electrophysiol. 2020;13(5):e008173. https://doi.org/10.1161/CIRCEP.119.008173