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Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Ablated Through a Percutaneous Trans-pericardial Approach
  • +9
  • Weizhu Ju,
  • jinlin zhang,
  • Linsheng Shi,
  • Kai Gu,
  • Ming Chu,
  • Hongwu Chen,
  • Gang Yang,
  • Mingfang Li,
  • Hailei Liu,
  • Fengxiang Zhang,
  • Bing YANG,
  • Minglong Chen
Weizhu Ju
Institution of Clinical cardiovascular center
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jinlin zhang
Wuhan Asian Heart Hospital
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Linsheng Shi
Institution of Clinical cardiovascular center
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Kai Gu
Institution of Clinical cardiovascular center
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Ming Chu
the First Affiliated Hospital of Nanjing Medical University
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Hongwu Chen
Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital
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Gang Yang
the First Affiliated Hospital of Nanjing Medical University
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Mingfang Li
the First Affiliated Hospital of Nanjing Medical Universit
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Hailei Liu
the First Affiliated Hospital of Nanjing Medical University
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Fengxiang Zhang
Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital
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Bing YANG
Shanghai East Hospital
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Minglong Chen
Institution of Clinical cardiovascular center
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Abstract

Aims Idiopathic epicardial ventricular arrhythmias (VAs) are clustered in the areas of the summit and crux. This study was to report a group of idiopathic epicardial VAs remote from the summit and crux areas. Methods In total, 9 patients (6 males, mean age 32±13 years) were enrolled. The locations were identified by epicardial mapping and ablation. The electrocardiographic and electrophysiological characteristics were compared to those of 9 patients who had VAs ablated at the opposite endocardial site. Results VAs were identified at the epicardium, with 4 patients had VAs located at the inferior wall, one at the anterior wall, one at the apex and 3 patients had VAs at the lateral wall. A “QS” type at the location-related leads was the only identified surface electrocardiogram indication suggesting epicardial origin (compared to that of the controls, 100% vs 0%, p<0.001). Endocardial and epicardial mapping revealed pre-maturities of -11±4 ms and -25±8 ms, respectively (VS. -28±8 ms revealed by endocardial mapping in control patients, p<0.001 and p=0.389, respectively). All of the study cases demonstrated an “rS” pattern in the endocardial unipolar electrogram. Acute and long-term successful ablation (a median of 11 months of follow-up) was achieved in all patients without complications. Conclusion A distinct group of idiopathic VAs remote from the summit and crux areas warranting ablation by a subxiphoid approach were identified. Morphological ECG features of a “QS” type among the location-related grouped leads combined with the mapping findings helped in the identification of the epicardial site of origin.