Aortic Sinus Cusp Research Articles

Ventricular tachycardia with a myocardial fibre travelling from the origin in the right aortic sinus cusp to the epicardial breakout site of the right ventricular outflow tract

A 74-year-old man with idiopathic ventricular tachycardia (VT) with a QRS morphology with a left bundle branch block and right inferior axis underwent electrophysiologic testing. Successful ablation was achieved at the right coronary cusp (RCC) where an excellent pace map with long stimulus-to-QRS interval (St-QRS) (85 ms) was obtained. An excellent pace map was also obtained on the epicardial surface approximately 1 cm away from the successful ablation site and the St-QRS was shorter (40 ms). These findings suggested that a myocardial fibre travelling from the origin in the RCC to the epicardium of the right ventricular outflow tract might exist.

Radiofrequency Catheter Ablation with the Use of a Noncontact Mapping System for Ventricular Tachycardia Originating from the Aortic Sinus Cusp —A Case Report—

Here we present a 15‐year old female in whom an idiopathic ventricular tachycardia (VT) originating from the left aortic sinus cusp was eliminated by radiofrequency catheter ablation (RFCA) under navigation using a noncontact mapping system (NCM). The dynamic activation map constructed with the NCM clearly identified a VT focus in the left aortic sinus cusp, from which the activation spread out to the entire left ventricle. At that site, the virtual unipolar electrogram recorded with the NCM was the same as the contact unipolar electrogram in terms of morphology and timing, a pre‐systolic potential preceding the QRS complex by 40 msec was recorded by contact bipolar electrogram and rapid pacing during sinus rhythm resulted in a perfect pace match. RFCA at that site eliminated the VT and the patient has had no recurrence during 10 months of follow‐up.

Dual Tachycardias Associating Double‐Exit Left Aortic Sinus Cusp Tachycardia with Paroxysmal Atrial Fibrillation: Evidence of a Link Between Both Arrhythmias by Means of the Autonomic Nervous System

Dual tachycardias associating paroxysmal atrial fibrillation (AF) with double-exit left aortic sinus cusp tachycardia (LASCT) are described for the first time in a patient referred for AF ablation. Both tachycardias were successfully ablated under Carto-Merge guidance. Noteworthy, vagal denervation during AF ablation was responsible for an immediate decrease in LASCT occurrence and inducibility. This case highlights the critical role that the autonomic nervous system plays within the cardiac arrhythmia framework.

Catheter ablation of ventricular arrhythmias originating in the vicinity of the His bundle: Significance of mapping the aortic sinus cusp

There is a close anatomical relationship between the right coronary cusp (RCC) and noncoronary aortic cusp (NCC) and sites recording His bundle (HB) activation in the right ventricle (RV). The purpose of this study was to examine the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs) that originate near the HB and their potential as predictors of successful catheter ablation sites. We studied 147 consecutive patients undergoing successful catheter ablation of idiopathic VAs originating from the ventricular outflow tract of either ventricle or the HB region. In 13 (9%) patients with an origin in the RCC (n = 5), NCC (n = 1), or RV HB region (n = 7), the local RV activation in the HB region preceded the QRS onset. In two VAs originating from the RCC or NCC, failed radiofrequency applications near the HB region in the RV delayed the near-field ventricular electrogram and separated the far-field electrograms before the QRS onset in the HB region. The QRS transition in the precordial leads did not discriminate between an RV origin near the HB and an NCC or RCC origin. A QS pattern in lead aVL might be helpful for predicting an RCC origin. VAs originating near the HB have similar electrocardiographic and electrophysiological characteristics, regardless of whether the ablation site is in the RV or aortic sinuses because of the close anatomical relationship of these structures and rapid transseptal conduction. When RV mapping reveals an earliest ventricular activation in the HB region during VAs, mapping in the RCC and NCC should be added to accurately identify the site of origin.

Preferential Conduction Across the Ventricular Outflow Septum in Ventricular Arrhythmias Originating From the Aortic Sinus Cusp

The purpose of this study was to examine the relationship between the origin and breakout site of idiopathic ventricular tachycardia (VT) or premature ventricular contractions (PVCs) originating from the myocardium around the ventricular outflow tract. The myocardial network around the ventricular outflow tract is not well known. We studied 70 patients with idiopathic VT (n = 23) or PVCs (n = 47) with a left bundle branch block and inferior QRS axis morphology. Electroanatomical mapping was performed in both the right ventricular outflow tract (RVOT) and aortic sinus cusp (ASC) during VT or PVCs. The earliest ventricular activation (EVA) was recorded in the RVOT in 55 patients (group R) and in the ASC in 15 (group A). In all group R patients, the closest pace map and successful ablation were achieved at the EVA site. Although a successful ablation was achieved at the EVA site in all group A patients, the closest pace map was obtained at the EVA site in 8 and RVOT in 7 (with an excellent pace map in 4). The stimulus to QRS interval was 0 ms during pacing from the RVOT and 36 +/- 8 ms from the ASC. The distance between the EVA and perfect pace map sites in those 4 patients was 11.9 +/- 3.0 mm. Ventricular arrhythmias originating from the ASC often show preferential conduction to the RVOT, which may render pace mapping or some algorithms using the electrocardiographic characteristics less reliable. In some of those cases, an insulated myocardial fiber across the ventricular outflow septum may exist.

Using the Initial Vector from Surface Electrocardiogram to Distinguish the Site of Outflow Tract Tachycardia

The purpose of this study is to determine whether initial vector force might best distinguish tachycardias arising from the right ventricular (RV) outflow tract (OT) versus aortic sinus cusps (ASCs). Among 45 patients with OT tachycardia, we measured the time from the earliest QRS onset in any lead to local onset and to the first QRS peak/nadir in each surface leads during VT. We compared the earliest phase differences among patients with foci in RVOT (n = 32) and in ASCs (n = 13) (determined by ablation), using unpaired t-tests. We determined the optimum cut-points by analyzing the receiver-operator characteristics curves, and derived an algorithm to discriminate ASC from RVOT foci. Compared with an RVOT focus, origin in the ASC was associated with lower likelihood that the earliest lead of QRS activation was V2 (4/13 [12%] vs 29/32 [88%], P = 0.0001), later initial peak/nadir in III (110 +/- 19 vs 93 +/- 16 ms, P = 0.0026) and V2 (75 +/- 26 vs 42 +/- 19 ms, P < 0.0001). After determining the optimum cut-points for each, we found that the presence of any one of these findings discriminated well between RVOT and ASC foci (sensitivity 92%, specificity 88%, positive predictive value 75%, and negative predictive value 97%). The sensitivity and specificity using standard ECG criteria were inferior to the vector approach. The ECG phase differences during VT can distinguish the origin of OT-VT. Earliest onset or first peak/nadir in V2 and early initial peak/nadir in the inferior leads suggest a RVOT focus.

Double-exit transaortic sinus cusp ventricular tachycardia: An unusual form of idiopathic outflow tract tachycardia treated by radiofrequency catheter ablation

D I d m s a a V a m t ( h u ntroduction n recent years, several case reports and small series of atients have described idiopathic ventricular tachycardia VT) amenable to ablation from the aortic sinus cusps. n the majority of patients, only one VT morphology could e documented clinically and by electrophysiologic testing. owever, in rare cases two different VTs could be ablated rom different anatomic sites in the same patient. We escribe the clinical course of a patient with idiopathic VT f two morphologies, which were ablated from a single site n the left aortic sinus cusp. “Double-exit” reentry is conidered the possible underlying mechanism.

P5-57: Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp

P5-57: Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp

AB5-1: Catheter ablation of paroxysmal supraventricular tachycardia originating from the non-coronary aortic sinus cusp

AB5-1: Catheter ablation of paroxysmal supraventricular tachycardia originating from the non-coronary aortic sinus cusp

332 Clinical implication of presystolic bipolar potential for successful ablation of ventricular tachycardia originating from the aortic sinus cusp

332 Clinical implication of presystolic bipolar potential for successful ablation of ventricular tachycardia originating from the aortic sinus cusp

332 Clinical implication of presystolic bipolar potential for successful ablation of ventricular tachycardia originating from the aortic sinus cusp

332 Clinical implication of presystolic bipolar potential for successful ablation of ventricular tachycardia originating from the aortic sinus cusp

A37-5 Clinical results of catheter ablation of ventricular tachycardia originating from the aortic sinus cusp

A37-5 Clinical results of catheter ablation of ventricular tachycardia originating from the aortic sinus cusp

A37-5 Clinical results of catheter ablation of ventricular tachycardia originating from the aortic sinus cusp

A37-5 Clinical results of catheter ablation of ventricular tachycardia originating from the aortic sinus cusp

Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp. Electrocardiographic characterization for guiding catheter ablation

Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp. Electrocardiographic characterization for guiding catheter ablation

Mapping and Ablation of Idiopathic VT Arising from the Aortic Sinus Cusp

When ventricular tachycardia (VT) occurs in patients without evidence of structural heart disease (i.e., idiopathic VT), it typically has a left bundle

Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: Electrocardiographic characterization for guiding catheter ablation

ObjectivesWe sought to investigate the electrocardiographic (ECG) characteristics for guiding catheter ablation in patients with repetitive monomorphic ventricular tachycardia (RMVT) originating from the aortic sinus cusp (ASC). BackgroundRepetitive monomorphic ventricular tachycardia can originate from the right ventricular outflow tract (RVOT) and ASC in patients with a left bundle branch block (LBBB) morphology and an inferior axis. MethodsActivation mapping and ECG analysis was performed in 15 patients with RMVT or ventricular premature contractions. The left main coronary artery (LMCA) was cannulated as a marker and for protection during radiofrequency delivery if RMVT originated from the left coronary ASC. ResultsDuring arrhythmia, the earliest ventricular activation was recorded from the superior septal RVOT in eight patients (group 1) and from the ASC in the remaining seven patients (group 2). The indexes of R-wave duration and R/S-wave amplitude were significantly lower in group 1 than in group 2 (31.8 ± 13.5% vs. 58.3 ± 12.1% and 14.9 ± 9.9% vs. 56.7 ± 29.5%, respectively; p < 0.01), despite similar QRS morphology. In five patients from group 2, RMVT originated from the left ASC, with a mean distance of 12.2 ± 3.2 mm (range 7.3 to 16.1) below the ostium of the LMCA. In the remaining two patients, the RMVT origin was in the right ASC. All arrhythmias were successfully abolished. None of the patients had recurrence or complications during 9 ± 3 months of follow-up. ConclusionsOn the surface ECG, RMVT from the ASC has a QRS morphology similar to that of RVOT arrhythmias. The indexes of R-wave duration and R/S-wave amplitude can be used to differentiate between the two origins. Radiofrequency ablation can be safely performed within the left ASC with a catheter cannulating the LMCA.