Idiopathic ventricular arrhythmias ablating from different subregions in the aortic sinus cusps: anatomic distribution, electrocardiography, and electrophysiology characteristics

Abstract

Abstract Background Previous studies had described the electrocardiographic or electrophysiological characteristics of ventricular arrhythmias (VAs) from 3 aortic sinus cusps (ASC) as a whole, while little is known about the differences among VAs ablated in different subregions of the ASC. Objective To investigate the distribution, specific precordial electrocardiographic sign, and bipolar electrogram characteristics of VAs ablated in different subregions of the ASC. Methods We divided the right coronary cusp (RCC) and the left coronary cusp (LCC) into 6 subregions and studied 51 idiopathic VAs ablated successfully in the ASC. Results Fifty-one VAs inhomogeneous distributed in the 6 subregions, which rarely located in the lateral RCC (L-RCC; 2%). The fractionated potential was dominant (39/51, 76%) in the three kinds of target electrograms. From the L-RCC to the lateral LCC (L-LCC), the percentage of fractionated potential gradually decreased from 100% to 59%. A precordial rebound notch in V3–4 or V4–5 had a sensitivity of 90.9%, a specificity of 85.0%, and a negative predictive value (NPV) of 97.1% to predict VAs ablating from the anterior RCC (A-RCC). A precordial rebound notch in V2–3 had a sensitivity of 50.0%, a specificity of 94.9%, and a NPV of 86.0% to predict VAs ablating from the L-LCC. Conclusion The targets of the ASC-VAs mainly distributed in the anterior ASC and the L-LCC. Fractionated potential is common among target bipolar electrograms especially in the anterolateral RCC. Precordial electrocardiographic rebound notch has a high predictive accuracy for identifying different subregions of the ASC-VAs. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2