| OBJECTIVE Although premature ventricular contraction(PVC)and ventricular tachycardias(VTs)originating from the aortic root can be treated by catheter ablation,reliable indicators of successful ablation site have not been fully identified.The aim of this study was to identify the characteristics of local electrograms that may be helpful in predicting successful ablation site.METHODS We included 132 consecutive patients with idiopathic PVC/VTs originating from the aortic root,who were managed by radiofrequency catheter ablation at our center between October 2008 and February 2016.The origin of the PVC/VTs were confirmed by endocardial mapping.Depending on the local eletrograms at the successful ablation site,132 patients were divided into two groups,local double potential(LDP)group and non-local double potential(non-LDP)group.RESULTS Out of these idiopathic PVC/VTs,56 idiopathic PVC/VTs originated from left coronary cusp(LCC).Right coronary cusp(RCC)had 39 patients,left and right coronary commissure(LCC-RCC)had 33 patients and noncoronary cusp(NCC)had 4 patients.Of the 132 patients,97 patients(73.5%)at the successful ablation site had the local double potential.Among these patients,44 patients(78.6%)in LCC,29 patients(74.4%)in RCC,21 patients(63.6%)in LCC-RCC commissure,and 3 patients(75.0%)in NCC.In LDP group,the time from the onset of the LDP at the successful ablation site to the QRS onset was 31 ±2ms compared with 26±3ms in non-LDP group,P=0.007.Meanwhile,less radiofrequency catheter ablation(RFCA)attempts was required in LDP group(3.6±1.2 vs.4.5±2.3,P<0.001).Over 40.4±28.8 months follow-up,7 patients have been recurrence,2 patients in LDP group compared with 5 patients in non-LDP group,P<0.001.CONCLUSIONS Local double potential was recorded in 97(73.5%)of 132 patients with idiopathic PVC/VTs originating from the aortic root.Local double potential was an effective and reliable indicator to identify the successful ablation site,and had a higher success rate through long time follow-up.OBJECTIVE The objective of this study was to assess electrocardiographic characteristics predicting the precise ablation site of premature ventricular contraction(PVC)and ventricular tachycardias(VTs)originating from the right coronary cusp(RCC)region.METHODS We included 39 consecutive patients(21 men,age 3 8±10 years)underwent successful catheter ablation of PVC/VTs originating from the RCC.Based on the fluoroscopy and 3-D electroanatomical mapping system,the successful ablation site of the PVC/VTs were divided into two groups,at the nadir of the RCC group and above the nadir of the RCC group.Surface 12-lead electrocardiogram during the PVC/VTs was analysed.RESULTS 6(15%)patients successfully ablated at the nadir of the RCC,and 33 patients ablated from RCC just above the nadir.According to the surface electrocardiographic findings,there were significant difference in the mean R-wave amplitude in inferior leads(1.4±0.2mV vs.1.8±0.2mV,P<0.05),R-wave amplitude ratio of lead ?/?(0.68±0.02 vs.0.64±0.04,P<0.05),incidence of r or R-wave in lead avL[6/6(100%)vs.5/33(15.2%),P<0.001],R-wave amplitude in lead ?(0.44±0.03mV vs.0.36±0.06mV,P<0.05),and incidence of S-wave in lead ?[3/6(50%)vs.1/33(3.03%),P=0.008]between the two groups.Depending on R-wave amplitude of 0.44mv in lead ?,mean R-wave amplitude of 1.3mv in inferior leads and R-wave amplitude ratio of 0.65 of lead ?/?,these electrocardiographic index can classify the successful ablation site.CONCLUSIONS Because of the complex anatomical and adjacent structure of the RCC,PVC/VTs originating from the RCC could be classified into two subgroups with distinct electrocardiographic characteristics.Our electrocardiographic findings can be reliable for estimating the successful catheter ablation site of RCC PVC/VTs.OBJECTIVE Idiopathic premature ventricular contraction(PVC)and ventricular tachycardias(VTs)originated from the aortic root can be successfully ablated.Left and right coronary artery ostium locate in the left coronary cusp(LCC)and right coronary cusp(RCC).Risk of coronary damage has led to recommendation of coronary angiography(CA)during the procedure.However,CA could increase the risk of vascular injury and coronary dissection.We describe an alternative method to assess relation of catheter and coronary ostium during ablation without additional vascular accesses by performing angiography through the tip of irrigated ablation catheter,and identify its safety and efficiency.METHODS We included 132 consecutive patients with idiopathic PVC/VTs originating from the aortic root,who were managed by radiofrequency catheter ablation at our center between October 2008 and February 2016.According to the different angiography method,132 patients were divided into the two groups,the common CA group and irrigated ablation catheter angiography group.RESULTS Out of these idiopathic PVC/VTs,56 idiopathic PVC/VTs originated from left coronary cusp(LCC).Right coronary cusp(RCC)had 39 patients,left and right coronary commissure(LCC-RCC)had 33 patients and noncoronary cusp(NCC)had 4 patients.Compared with through common CA(n=20)confirmed the safety distance between the tip of ablation catheter and coronary ostium,angiography through the irrigated ablation catheter in aortic root reduced the dose of contrast agent(8.6±2.7 ml vs.21.6±7.7ml,P<0.001).Hematoma occurred at the puncture site because of additional vascular access in the common CA group.No coronary damage needed interventional therapy occurred neither during the procedure nor follow-up(40.4±28.8 months).The recurrence rate over long time follow-up was similar between the two groups[1 vs.6,P=1.0].No technical problems occurred with the ablation catheter after contrast injection.CONCLUSIONS Angiography through irrigated ablation catheter is safe and effective to assess relation of coronary ostium and ablation site during ablation in aortic root compared with common coronary angiography.It allows continuous realtime assessment and reduce the dose of contrast agent.This angiography method reduce the puncture complication because of no additional vascular access needed. |
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