4 years ago

Idiopathic Ventricular Arrhythmias Originating From the Right Coronary Sinus: Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Catheter Ablation

Ventricular arrhythmias (VAs) of right coronary cusp (RCC) are not fully characterized. Objectives To investigate the electrocardiographic and electrophysiologic characteristics, mapping and ablation of RCC-VAs. Methods Among 256 consecutive patients undergoing electrophysiologic evaluation and ablation of VAs of ventricular outflow tract origin, data were compared among 27 RCC-VAs, 50 VAs of the septal aspect of right ventricular outflow tract (RVOT, including from pulmonary artery) and 9 VAs of left coronary cusp (LCC). Results The only ECG characteristic that differentiated VAs originating from the RCC and RVOT was the amplitude of the R wave in lead I. During VAs of RCC, the earliest activation site (EAS) in right ventricular was localized in the middle-posterior septal of RVOT. The distance between His bundle and the EAS in RVOT in RCC group was shorter than in RVOT and LCC group, the distance ≤ 29.4mm rules out RVOT and LCC origin, had 92.6% sensitivity and 100% specificity for RCC origin speculation. Double or complex potentials was recorded in RVOT middle-posterior septal area surrounding EAS in 20/27(70%)patients. Most of successful ablation sites(24/27)were located in anterior and upper margin of RCC close to middle-posterior septal of RVOT. Prepotential (P1) amplitude and P1-to-QRS complex interval may be indicators of successful RCC-VAs ablation sites. Conclusions RCC-VAs are not uncommon and have unique electrocardiographic and electrophysiologic characteristics that distinguishes RCC origin from RVOT and LCC origin. Most RCC-VAs were ablated successfully in anterior and upper aspects of RCC.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310871

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