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Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the left ventricular basal inferoseptum recess near the mitral annulus

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Abstract

Purpose

We sought to clarify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the left ventricular basal inferoseptum recess near the mitral annulus (LV-BIS-MA).

Methods

Twenty-five patients with acute successful RFCA at the LV-BIS-MA were included in this study.

Results

The S-wave amplitudes on lead III during VAs were 1.54 ± 0.38 mV, significantly larger than those on lead II (0.55 ± 0.19 mV) and aVF (1.04 ± 0.31 mV) (P < 0.01). Precordial R/S > 1 transition before lead V2 and S-waves in lead V6 was recorded in 100% and 48.0% of patients, respectively. The earliest bipolar activation preceded the QRS onset by 32.3 ± 11.5 ms. Pace mapping demonstrated perfect QRS morphology matching in only 56.0% of patients. The RFCA start-to-effect time was 10.2 ± 5.8 seconds (s) in 21 patients (84.0%). In the remaining 4 patients (16.0%), the mean duration of successful RFCA was not well determined due to the infrequent presence of clinical VAs during ablation. The trans-septal approach was utilized in all 25 cases. Intra-cardiac echocardiography (ICE) showed that the ablation catheter tip was underneath the anterior leaflet of the mitral valve via the reversed C-curve technique. Early (within 3 days) and late (1 year) recurrence rates were 4.0% (one patient) and 12.0% (three patients), respectively. No complications during RFCA or at the 1-year follow-up.

Conclusions

LV-BIS-MA VAs are a subgroup of idiopathic VAs with distinctive ECG and EP features. RFCA via a trans-septal approach using a reversed C-curve technique is effective for better identification and targeting of the areas of VAs origin, and ICE showed that the ablation catheter tip was underneath the anterior leaflet of the mitral valve.

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Authors and Affiliations

  1. Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China

    Chengye Di, Peng Gao, Qun Wang, Yanxi Wu & Wenhua Lin

  2. College of Clinical Cardiology, Tianjin Medical University, Tianjin, China

    Chengye Di, Peng Gao, Qun Wang, Yanxi Wu & Wenhua Lin

  3. Cardiovscular Institute, Tianjin University, Tianjin, China

    Chengye Di, Peng Gao, Qun Wang, Yanxi Wu & Wenhua Lin

Authors
  1. Chengye Di
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  2. Peng Gao
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  3. Qun Wang
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  4. Yanxi Wu
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  5. Wenhua Lin
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Correspondence to Wenhua Lin.

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This study was approved by the TEDA International Cardiovascular Hospital ethics committee for clinical research. All patients provided written informed consent.

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The authors declare no conflicts of interest.

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Di, C., Gao, P., Wang, Q. et al. Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the left ventricular basal inferoseptum recess near the mitral annulus. J Interv Card Electrophysiol 66, 281–290 (2023). https://doi.org/10.1007/s10840-021-00983-3

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  • DOI: https://doi.org/10.1007/s10840-021-00983-3

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