Ventricular arrhythmias with superior axis originating from the left ventricular septum: electrocardiographic characteristics predicting successful ablation and insights into their mechanism-observations from a small series of patients.

Autor:	Kusa S; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan shigeki_kusa@wine.ocn.ne.jp., Hachiya H; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Iwasawa J; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Ichihara N; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Komatsu Y; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Taniguchi H; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Miyazaki S; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Nakamura H; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan., Iesaka Y; Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-Shinmachi, Tsuchiura, Ibaraki 300-0053, Japan.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2015 Oct; Vol. 17 (10), pp. 1587-95. Date of Electronic Publication: 2015 Mar 10.
DOI:	10.1093/europace/euu396
Abstrakt:	Aims: This study aimed to evaluate the electrocardiographic characteristics and predictors of successful ablation for ventricular arrhythmias (VAs) with superior axis originating in the ventricular septum. Methods and Results: This study included 385 consecutive patients with VAs undergoing radiofrequency ablation (RFA). Of these, 14 patients (3.7%) were identified who had VAs with superior axis that were mapped to and ablated at the left ventricular (LV) septum. These patients were classified into two groups, successful (n = 9, Success-RFA) and failed (n = 5, Fail-RFA) ablation. The QRS duration of the VAs was longer in the Success-RFA than the Fail-RFA [median (25%, 75% quartile), 140 (134, 149) vs. 128 (116, 132) ms; P = 0.007]. In the Success-RFA, the QRS morphology in lead V1 exhibited qR or rSR (r < 0.2 mV) pattern. In the Fail-RFA, QRS in lead V1 demonstrated an initial R-wave of ≥0.2 mV except for one patient who demonstrated a qR pattern. The initial R-wave amplitude of <0.2 mV in lead V1 identified successful ablation cases with 100% sensitivity and 80% specificity. The magnitude of the initial R-wave amplitude in lead V1 could be related to the originating site's depth within the septal tissue, which could also explain the RFA results. Conclusion: Four percent of VA patients had superior axis on electrocardiogram and foci that mapped to the LV septum, two-thirds of which were successfully ablated. The initial R-wave amplitude of <0.2 mV in lead V1 identified RFA success with high sensitivity and specificity. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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