Atypical variants of right ventricular outflow arrhythmias

Siva Mulpuru, Tomas Konecny, Malini Madhavan, Suraj Kapa, Peter Noseworthy, Christopher J. McLeod, Paul Andrew Friedman, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

RVOT Atypical Variants Background Right ventricular outflow tract (RVOT) arrhythmias are a common form of ventricular tachycardia (VT) in patients with structurally normal heart. The underlying mechanism is due to triggered activity. Mapping and ablation is relatively straightforward targeting the earliest point of activation. Previously reported causes of difficult ablation in the RVOT region include under recognized right ventricular cardiomyopathy/sarcoidosis, presence of endocavitary structures, close proximity to the coronary vasculature, and origin from non-RVOT structures. Methods and Results We identified all patients undergoing PVCs/sustained RVOT VT ablation from January 2013 to December 2013. This included 33 patients. Of these, we identified procedures that were considered difficult despite a single morphology arrhythmia being targeted and no underlying cardiomyopathy present. Difficulty was specifically considered when ablation at the earliest site of activation was not successful and eventual successful ablation was at a distance of greater than 15 mm from the early activation site. We identified 3 patients (n = 3, 100% male) with evidence of reentrant arrhythmia based on slow conduction zones necessary for the tachycardia/arrhythmia, mid diastolic signals during VT or preceding bigeminal PVCs, pace mapping from the site abnormal signals reproducing the arrhythmia morphology but with prominent conduction delay, the entire cycle length of the tachycardia or coupling interval for the PVCs being mapping, or based on reset characteristics. Conclusion In patients with atypical forms of RVOT VT, careful mapping and ablation of the myocardial sleeves near the pulmonic valve can eliminate the arrhythmia.

Original languageEnglish (US)
Pages (from-to)1321-1327
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2014

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Cardiac Arrhythmias
Ventricular Tachycardia
Polyvinyl Chloride
Cardiomyopathies
Tachycardia
Sarcoidosis
Lung

Keywords

  • myocardial sleeves
  • RVOT VT
  • supravalvar arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atypical variants of right ventricular outflow arrhythmias. / Mulpuru, Siva; Konecny, Tomas; Madhavan, Malini; Kapa, Suraj; Noseworthy, Peter; McLeod, Christopher J.; Friedman, Paul Andrew; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 12, 01.12.2014, p. 1321-1327.

Research output: Contribution to journalArticle

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N2 - RVOT Atypical Variants Background Right ventricular outflow tract (RVOT) arrhythmias are a common form of ventricular tachycardia (VT) in patients with structurally normal heart. The underlying mechanism is due to triggered activity. Mapping and ablation is relatively straightforward targeting the earliest point of activation. Previously reported causes of difficult ablation in the RVOT region include under recognized right ventricular cardiomyopathy/sarcoidosis, presence of endocavitary structures, close proximity to the coronary vasculature, and origin from non-RVOT structures. Methods and Results We identified all patients undergoing PVCs/sustained RVOT VT ablation from January 2013 to December 2013. This included 33 patients. Of these, we identified procedures that were considered difficult despite a single morphology arrhythmia being targeted and no underlying cardiomyopathy present. Difficulty was specifically considered when ablation at the earliest site of activation was not successful and eventual successful ablation was at a distance of greater than 15 mm from the early activation site. We identified 3 patients (n = 3, 100% male) with evidence of reentrant arrhythmia based on slow conduction zones necessary for the tachycardia/arrhythmia, mid diastolic signals during VT or preceding bigeminal PVCs, pace mapping from the site abnormal signals reproducing the arrhythmia morphology but with prominent conduction delay, the entire cycle length of the tachycardia or coupling interval for the PVCs being mapping, or based on reset characteristics. Conclusion In patients with atypical forms of RVOT VT, careful mapping and ablation of the myocardial sleeves near the pulmonic valve can eliminate the arrhythmia.

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