Idiopathic Ventricular Arrhythmias Originating From the Aortic Root. Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Results of Radiofrequency Catheter Ablation

Takumi Yamada, H. Thomas McElderry, Harish Doppalapudi, Yoshimasa Murakami, Yukihiko Yoshida, Naoki Yoshida, Taro Okada, Naoya Tsuboi, Yasuya Inden, Toyoaki Murohara, Andrew E. Epstein, Vance J. Plumb, Satinder P. Singh, G. Neal Kay

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155 Scopus citations

Abstract

Objectives: This study investigated the prevalence and electrocardiographic and electrophysiologic characteristics of aortic root ventricular arrhythmias (VAs). Background: Idiopathic VAs originating from the ostium of the left ventricle may be ablated at the base of the aortic cusps. Methods: We studied 265 patients with idiopathic VAs with an inferior QRS-axis morphology. Results: The successful ablation site was within (or below) the aortic cusps in 44 patients (16.6%). The site of the origin was the left coronary cusp (LCC) in 24 (54.5%), the right coronary cusp (RCC) in 14 (31.8%), the noncoronary cusp (NCC) in 1 (2.3%), and at the junction between the LCC and RCC (L-RCC) in 5 (11.4%) cases. The maximum amplitude of the R-wave in the inferior leads was significantly greater with an LCC than with an RCC origin (p < 0.05). The ratio of the R-wave amplitude in leads II and III was significantly greater with an LCC than with an RCC origin (p < 0.01) and was significantly smaller in the NCC than in the other sites (p < 0.0001). The ventricular deflection in the His bundle electrogram was significantly later relative to the surface QRS with an LCC or L-RCC origin than with an RCC or NCC origin (p < 0.0001). The ratio of the atrial-to-ventricular deflection amplitude was significantly greater in the NCC than in the other sites (p < 0.0001). No other factors predicted the site of origin. Conclusions: Idiopathic VAs are more common in the LCC than in the RCC and rarely arise from the NCC. The electrocardiogram is useful for differentiating the site of origin.

Original languageEnglish (US)
Pages (from-to)139-147
Number of pages9
JournalJournal of the American College of Cardiology
Volume52
Issue number2
DOIs
StatePublished - Jul 8 2008
Externally publishedYes

Keywords

  • aortic root
  • characteristics
  • prevalence
  • radiofrequency catheter ablation
  • ventricular arrhythmia

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