Skip to main content
SpringerLink
Log in

Relationship between electroanatomical voltage mapping characteristics and breakout site of ventricular activation in idiopathic ventricular tachyarrhythmia originating from the right ventricular outflow tract septum

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Objective

To assess the electrophysiological characteristics of the breakout site of ventricular activation using electroanatomical voltage mapping (EVM) and its relation to the optimal ablation site in idiopathic ventricular tachyarrhythmias originating from the outflow tract of the (RVOT) septum.

Methods

Twenty-eight patients with symptomatic drug-refractory premature ventricular complexes (PVCs) and/or ventricular tachycardia (VT) originating from the RVOT septum and 5 control subjects with WPW syndrome were included. Low-voltage areas (LVAs) were defined as signal amplitudes between 0.1 and 1.5 mV. The borderline between the normal area and the LVA was defined as “border,” and the distance from the LVA to the border (length of LVA) was measured.

Results

In all 28 patients and control subjects, there was an LVA below the pulmonary valve. There was no significant difference in length of LVA between patients with idiopathic ventricular arrhythmias and control subjects (2.0 ± 0.6 vs. 1.9 ± 0.1 cm). In 19 of the 28 patients, the optimal ablation site was identical to the border area. In all 11 patients who had pre-potentials at the successful ablation site, there were two cases with polymorphic VT and/or ventricular fibrillation associated with PVCs. In these two cases, length of LVA was longer than in other patients (4.0 and 3.9 cm vs. 1.8 ± 0.5 cm (n = 26)), and the optimal ablation site was located at the border area.

Conclusion

The border area, including the LVA, tends to be the breakout site and/or origin of ventricular arrhythmias in idiopathic ventricular tachyarrhythmia originating from the RVOT septum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Buxton, A. E., Waxman, H. L., Marchlinski, F. E., Simson, M. B., Cassdy, D., & Josephson, M. E. (1983). Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation, 68(5), 917–927.

    Article  PubMed  CAS  Google Scholar 

  2. Morady, F., Kadish, A. H., DiCarlo, L., Kou, W. H., Winston, S., deBuitlier, M., et al. (1990). Long-term results of catheter ablation of idiopathic right ventricular tachycardia. Circulation, 82(6), 2093–2099.

    Article  PubMed  CAS  Google Scholar 

  3. Kamakura, S., Shimizu, W., Matsuo, K., Taguchi, A., Suyama, K., Kurita, T., et al. (1998). Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation, 98(15), 1525–1533.

    PubMed  CAS  Google Scholar 

  4. Yamada, T., Murakami, Y., Yoshida, N., Okada, T., Shimizu, T., Toyama, J., et al. (2007). Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp. Journal of the American College of Cardiology, 50(9), 884–891.

    Article  PubMed  Google Scholar 

  5. Boulos, M., Lashevsky, I., Reisner, S., & Gepstein, L. (2001). Electroanatomical mapping of arrhythmogenic right ventricular dysplasia. Journal of the American College of Cardiology, 38(7), 2020–2027.

    Article  PubMed  CAS  Google Scholar 

  6. Marchlinski, F. E., Zado, E., Dixit, S., Gerstenfeld, E., Callans, D. J., Hsia, H., et al. (2004). Electroanatomic substrate and outcome of catheter ablative therapy for ventricular tachycardia in setting of right ventricular cardiomyopathy. Circulation, 110(16), 2293–2298.

    Article  PubMed  Google Scholar 

  7. Corrado, D., Basso, C., Leoni, L., Tokajuk, B., Bauce, B., Frigo, G., et al. (2005). Three-dimensional electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation, 111(23), 3042–3050.

    Article  PubMed  Google Scholar 

  8. Corrado, D., Basso, C., Leoni, L., Yokajuk, B., Turrini, P., Bauce, B., et al. (2008). Three-dimensional electroanatomical voltage mapping and histologic evaluation of myocardial substrate in right ventricular outflow tract tachycardia. Journal of the American College of Cardiology, 51(7), 731–739.

    Article  PubMed  Google Scholar 

  9. Iijima, K., Chinushi, M., Furushima, H., Hosaka, Y., Izumi, D., & Aizawa, Y. (2009). Ventricular fibrillation triggered during and after radiofrequency energy delivery to the site of origin of idiopathic right ventricular outflow tract arrhythmia. Pacing and Clinical Electrophysiology, 32(3), 406–9.

    Article  PubMed  Google Scholar 

  10. McKenna, W. J., Thiene, G., Nava, A., Fontaliran, F., Blomstrom-Lundqvist, C., Fontaine, G., et al. (1994). Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology. British Heart Journal, 71(3), 215–218.

    Article  PubMed  CAS  Google Scholar 

  11. Yamashita, Y., Yagi, T., Namekawa, A., Ishida, A., Sato, H., Nakagawa, T., et al. (2009). Distribution of successful ablation sites of idiopathic right ventricular outflow tract tachycardia. Pacing and Clinical Electrophysiology, 32, 727–733.

    Article  Google Scholar 

  12. Ouyang, F., Fotuhi, P., Volkmer, M., Goya, M., Burns, M., Ant, M., et al. (2002). Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. Journal of the American College of Cardiology, 39(3), 500–508.

    Article  PubMed  Google Scholar 

  13. Franco, D., Lamers, W. H., & Moorman, A. F. (1998). Patterns of expression in the developing myocardium: towards a morphologically integrated transcriptional model. Cardiovascular Research, 38(4), 25–53.

    Article  PubMed  CAS  Google Scholar 

  14. Christoffels, V. M., Habets, P. E. M. H., Franco, D., Campione, M., de Jong, F., Lamers, W. H., et al. (2000). Chamber formation and morphogenesis in the developing mammalian heart. Developmental Biology, 223(2), 266–278.

    Article  PubMed  CAS  Google Scholar 

  15. Ruzicka, D. L., & Schwartz, R. J. (1988). Sequential activation of alpha-actin gene during avian cardiogenesis: vascular smooth muscle alpha-actin gene transcripts mark the onset of cardiomyocyte differentiation. The Journal of Cell Biology, 107(6), 2575–2586.

    Article  PubMed  CAS  Google Scholar 

  16. Moorman, A. F., & Christoffels, V. M. (2003). Cardiac chamber formation: development, genes, and evolution. Physiological Reviews, 83(4), 1223–1267.

    PubMed  CAS  Google Scholar 

  17. Corrado, D., Basso, C., Thiene, G., McKenna, W. J., Davies, M. J., Fontaliran, F., et al. (1997). Spectrum of clinico-pathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia. A multicenter study. Journal of the American College of Cardiology, 30(6), 1512–1520.

    Article  PubMed  CAS  Google Scholar 

  18. Haissaguerre, M., Shoda, M., Jais, P., Nogami, A., Shah, D. C., Kautzner, J., et al. (2002). Mapping and ablation of idiopathic ventricular fibrillation. Circulation, 106(6), 962–967.

    Article  PubMed  Google Scholar 

  19. Aizawa, Y., Tamura, M., Chinushi, M., Niwano, S., Kusano, Y., Naitoh, N., et al. (1992). An attempt at electrical catheter ablation of the arrhythmogenic area in idiopathic ventricular fibrillation. American Heart Journal, 123(6), 257–260.

    Article  PubMed  CAS  Google Scholar 

  20. Noda, T., Shimizu, W., Taguchi, A., Aiba, T., Satomi, K., Suyama, K., et al. (2005). Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. Journal of the American College of Cardiology, 46(7), 1288–1294.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The First Department of Internal Medicine, Niigata University School of Medicine, 1-754 Asahi-machi-dori, Niigata, 951-8510, Japan

    Hiroshi Furushima, Masaomi Chinushi, Kenichi Iijima, Daisuke Izumi, Yukio Hosaka & Yoshifusa Aizawa

Authors
  1. Hiroshi Furushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaomi Chinushi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenichi Iijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Izumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukio Hosaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshifusa Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Furushima.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Furushima, H., Chinushi, M., Iijima, K. et al. Relationship between electroanatomical voltage mapping characteristics and breakout site of ventricular activation in idiopathic ventricular tachyarrhythmia originating from the right ventricular outflow tract septum. J Interv Card Electrophysiol 33, 135–141 (2012). https://doi.org/10.1007/s10840-011-9623-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-011-9623-8

Keywords

Search

Navigation