Catheter ablation of ventricular arrhythmias originating from the sinus
of valsalva: the reminder from the mapping or ablation in the lower
right ventricular outflow tract
Abstract
Background Ventricular arrhythmias (VAs) originating from ventricular
outflow tracts can possess a high similarity of QRS configuration
resulting in an inaccurate localization, while the reminder of mapping
or ablation in the lower right ventricular outflow tract (RVOT) commonly
provide the preferred transformation strategy. Methods We
retrospectively analyzed the total of 958 patients who were referred for
radiofrequency (RF) ablation of VAs in our center. VAs with the sinus of
valsalva (SoV) origins were enrolled. Results A total of 120 consecutive
patients (mean age 45.0 ± 15.5 years) undergoing the ablation of VAs
arising from the left-sided ventricular outflow tracts were included,
with 55 (45.8%) female. All patients had a QRS morphology of the LBBB
pattern and an inferior axis, with the mean earliest ventricular
activation (EVA) of target site of 34.9 ± 8.8ms. 37 (30.8%), 60
(50.0%), and 23 (19.2%) patients obtained the successful RF ablation
at the right sinus cusp (RCC), left sinus cusp (LCC), and the commissure
of RCC and LCC (R-LCC), respectively. 62 (51.7%) target sites of SoV
could record a high-frequency potential. Moreover, 25 (20.8%) patients
were continuously recorded an early ventricular activation in the lower
RVOT and achieved the elimination of VAs in SoV. Conclusions VAs
originating from the SoV could show a low specificity of QRS morphology
mimicking the RVOT-like ECG feature. An early ventricular activation
mapped in the lower RVOT or RF ablation with poor response likely
demonstrated the VAs originating from the SoV, especially the RCC.