Idiopathic ventricular arrhythmias arising from the posterior septum of tricuspid and mitral annuli: comparison of electrocardiographic characteristics and outcomes of catheter ablation

Eiji Sato, Tetsuo Yagi, Akihiko Ishida, Yoshiaki Mibiki, Yoshihiro Yamashina, Hirokazu Sato, Takashi Nakagawa, Kosuke Aoki, Keisuke Suzuki, Izutsu Takuma, Tomoyuki Yambe

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Purpose: Ventricular arrhythmia (VA) arising from the tricuspid annulus in the posterior septum (PS) (TAPS-VA) has similar electrocardiographic characteristics as VA arising from the mitral annulus in the PS (MAPS-VA) because the two locations are adjacent. We examined the electrocardiographic characteristics that differentiate MAPS-VA from TAPS-VA and the efficacy of catheter ablation. Methods: We studied 13 patients whose VAs were successfully ablated in the TAPS (n = 7) and MAPS (n = 6). Results: QRS morphologies of both groups were characterized by left and right bundle block morphologies in lead V1, superior axis deviation, and precordial transition at ≤ lead V3 in nine patients. Compared with TAPS-VA, MAPS-VA had (1) R < S wave in lead II, (2) precordial transition in lead V2, (3) s-wave in lead V6, and (4) slurred initial part of the QRS complex in the precordial leads, e.g., [4a] pseudo delta wave ≥ 34 ms, [4b] intrinsicoid deflection time ≥ 85 ms, and [4c] maximum deflection index ≥ 0.55. Patients who met ≥ 2 of (1)–(3) and any of [4a]–[4c] could be classified as having MAPS-VA, with a sensitivity and specificity of 100%. VA recurred in one patient in the TAPS group during the median follow-up of 7 (interquartile range 6 to 15.5) months. Conclusions: VA arising from the PS has superior axis deviation, and left and right bundle block morphologies with relatively early precordial transition. MAPS-VA can be differentiated from TAPS-VA based on electrocardiographic characteristics. This study provides useful information for treatment involving catheter ablation for VA arising from the PS.

Original languageEnglish
Pages (from-to)125-134
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume54
Issue number2
DOIs
Publication statusPublished - 2019 Mar 15

Keywords

  • Catheter ablation
  • ECG
  • Mitral annulus
  • Posterior septum
  • Tricuspid annulus
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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