Abstract
IntroductionVentricular arrhythmias (VAs) have been successfully ablated from the pulmonary sinus cusps establishing pulmonary artery (PA) as a distinct site of arrhythmic foci. The aim of the present study was to determine the clinical presentation, electrocardiographic, and ablation characteristics of PA‐VAs.MethodsThirty consecutive patients with right ventricular outflow tract (RVOT)‐type VAs were included in this retrospective study. Three‐dimensional electroanatomic mapping was performed in all patients. Mapping was performed initially in RVOT, and later within the PA. Mapping was performed in the PA if there was no early activation, unsatisfactory pace‐map, or ablation in RVOT were unsuccessful. All PA‐VAs were mapped and ablated by looping the catheter in a reverse U fashion.ResultsAmong 30 patients, 8 (26.6%) patients VAs were successfully ablated within PA. Electrocardiography (ECG) revealed that the QRS duration was significantly wider in the PA‐VAs group compared to the RVOT‐VAs group (155 ± 14.14 vs 142.40 ± 8.12 ms, P < .01). Mapping by reversed U method of PA‐VAs revealed earlier activation (55 ± 9.66 vs 12.00 ± 8.61 ms, P < .01) in PA compared to RVOT. An isolated discrete prepotential was present at the successful site in 50% (n = 4).ConclusionPulmonary artery‐VAs are an important subset of VA originating from the outflow tract. They have a wider baseline QRS duration compared to RVOT‐VAs. Presence of a prepotential aids in the identification of a successful ablation site. Mapping utilizing the reversed U method can help in localization and successful ablation of PA‐VAs.
Highlights
Ventricular arrhythmias (VAs) have been successfully ablated from the pulmonary sinus cusps establishing pulmonary artery (PA) as a distinct site of arrhythmic foci
Pace-map score in pulmonary artery derived ventricular arrhythmia (PA-VA) group was better in PA compared to right ventricular outflow tract (RVOT) (14.25 ± 4.06 vs 21.37 ± 2.06, P < .01)
This finding is consistent with the study by Zang et al where most of the PA-VAs were from anterior pulmonary cusp (APC) and RPC.[8]
Summary
Idiopathic ventricular arrhythmias (VAs) account for approximately 10% of patients referred for VA evaluation.[1–4] Majority of these VAs originate from the outflow tract. Idiopathic ventricular arrhythmias (VAs) account for approximately 10% of patients referred for VA evaluation.[1–4]. Majority of these VAs originate from the outflow tract. The success rate of catheter ablation of these arrhythmias is approximately 80%–95%.5. Ablation of outflow tract VAs originating from the pulmonary artery (PA) was first described by Timmermans et al[6]. Few studies have demonstrated successful ablation of VAs above the pulmonary sinus cusp (PSC) establishing the PA as a distinct site of right ventricular outflow tract (RVOT)-VAs.[7–9]. There is no uniform approach or ablation strategy for this subset of VAs. The objectives of this study were to describe the clinical presentation, electrocardiographic, and ablation characteristics of PA-VAs in comparison with RVOT-VA
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
