References:
- Kredieh B, Rodriguez-Manero M, Schurmann P, Ibarra-Cortez SH, Dave AS,
Valderrabano M. Retrograde coronary venous ethanol infusion for
ablation of refractory ventricular tachycardia. Circ Arrhythm
Electrophysiol. 2016, 9; e004352
- Anderson RH, Mohun TJ, Sanchez-Quintana D, Mori S, Spicer DE, Cheung
JW, Lerman BB. The anatomic substrates for outflow tract arrhythmias.
Heart Rhythm 2019; 16: 290-297
- Hachiya H, Yamauchi Y, Iesaka Y, Yagishita A, et al. Discrete
pre-potential as an indicator of successful ablation in patients with
coronary cusp ventricular arrhythmia. Circ Arrhythm Electrophysiol
2013; 6: 898-904
- Liao H, Mei W, Tanager KS, Miele F, et al. Left ventricular summit
arrhythmias with an abrupt V3 transition: Anatomy of the aortic
interleaflet triangle vantage point. Heart Rhythm 2021; 18: 10-19
- Anderson RD, Kumar S, Parmeswaran R, et al. Differentiating right- and
left-sided outflow tract ventricular arrhythmias: Classical ECG
signatures and prediction algorithms. Circ Arrhythm Electrophysiol
2019; 12: e007392
- Bradfield JS, Homsi M, Shivkumar K, Miller JM. Coupling interval
variability differentiates ventricular ectopic complexes arising in
the aortic sinus of Valsalva and great cardiac vein from other
sources.
- Waight MC, Li AC, Leung LW, et al. Hourly variability in outflow tract
ectopy as a predictor of its site of origin. Present issue of this
journal
- Hsia BC, Greige N, Patel SK, et al. Determining the optimal duration
for premature ventricular contraction monitoring. Heart Rhythm 2020;
17: 2119-2125
- Janse MJ, Coronel R, G Wilms-Schopman FJ, de Groot J. Mechanical
effects on arrhythmogenesis: from pipette to patient. Progress in
Biophys Mol Biol 2003; 82: 187-195
Figure legends:
Figure 1: Delayed activation recorded in left coronary sinus
during PVC. The electrograms marked by the blue arrows represent delayed
activation of local muscle bundle during sinus rhythm. The delay is
likely due to insulation by surrounding fibrous tissue of the
ventriculo-aortic junction. The more rounded early electrogram that
correspond in timing to the QRS is the electrogram generated by
activation of larger muscle of the LV summit. During PVC (second complex
in the trace), this electrogram represents earliest activation (black
arrow, 40ms pre-systolic) suggesting site of origin of the PVC. PVC =
premature ventricular contraction.
Figure 2: Electroanatomic map in the left anterior oblique view
with caudal tilt of the ventricular outflow region showing the RV
outflow, aortic leaflets and coronary sinus. Earliest activation (red,
early; purple, late) is registered in the distal great cardiac vein
overlying the LV summit. Ablation suppressed PVCs in the infra-aortic
region (blue solid circle) below the commissure of the right and left
aortic valve leaflets where electrograms were indistinct. RCC = Right
coronary cusp; LCC = left coronary cusp; NCC = non coronary cusp.