Volume 13, Issue 1, Pages (January 2016)

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Presentation transcript:

Volume 13, Issue 1, Pages 111-121 (January 2016) Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: Electrocardiographic characteristics and correlative anatomy Chin-Yu Lin, MD, Fa-Po Chung, MD, Yenn-Jiang Lin, MD, PhD, Eric Chong, MBBS, Shih-Lin Chang, MD, PhD, Li-Wei Lo, MD, PhD, Yu- Feng Hu, MD, PhD, Ta-Chuan Tuan, MD, Tze-Fan Chao, MD, Jo-Nan Liao, MD, Yao-Ting Chang, MD, Yun-Yu Chen, MPH, Chun-Ku Chen, MD, Chuen-Wang Chiou, MD, Shih-Ann Chen, MD, Hsuan-Ming Tsao, MD Heart Rhythm Volume 13, Issue 1, Pages 111-121 (January 2016) DOI: 10.1016/j.hrthm.2015.08.030 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Examples of the electrocardiographic morphology of ventricular arrhythmias originating from different successful sites in 4 groups. ASV = aortic sinus of Valsalva; GCV/AIV = great cardiac vein/anterior interventricular vein. *Epicardium requiring pericardial access. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Box plot and scatterplot demonstrating the differences and the distribution of the aVL/aVR Q-wave ratio of VAs originating from different sites. Box plot: upper horizontal line of box, 75th percentile; lower horizontal line of box, 25th percentile; horizontal bar within box, median; upper horizontal bar outside box, 90th percentile; lower horizontal bar outside box, 10th percentile. Scatter plot: distribution of aVL/aVR Q-wave ratio in 4 groups. ASV = aortic sinus of Valsalva; GCV/AIV = great cardiac vein/anterior interventricular vein; ROC = receiver operating characteristic. *Epicardium requiring pericardial access. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Application of the aVL/aVR Q-wave ratio on the LV summit ventricular arrhythmia. A: ROC curve analysis of the aVL/aVR Q-wave ratio can predict the subvalvular, GCV/AIV, or epicardial approaches. B: Three-step algorithm for identifying the successful ablation site origin from the LV summit area with a positive and a negative predictive rate of 89.4% and 97.9%, respectively. ASV = aortic sinus of Valsalva; AUC = area under the curve; GCV/AIV = great cardiac vein/anterior interventricular vein; LV = left ventricular; ROC = receiver operating characteristic. *Epicardium requiring pericardial access. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 A: Correlation between the aVL/aVR Q-wave ratio and the anatomical distances between the successful ablation site and the tip of the LV summit (Pearson correlation r = .863; P < .001). B: ROC curve analysis of the anatomical distances between the successful ablation site and the tip of the LV summit predicted the GCV/AIV or epicardial approaches. C: Box plot showing the local wall thickness of the successful site (mm) in the 4 groups with different successful ablation sites. D: ROC curve analysis of the local wall thickness of the successful ablation site (mm) can predict the requirement of the GCV/AIV or epicardial approach. Box plot: upper horizontal line of box, 75th percentile; lower horizontal line of box, 25th percentile; horizontal bar within box, median; upper horizontal bar outside box, 90th percentile; lower horizontal bar outside box, 10th percentile. ASV = aortic sinus of Valsalva; AUC = area under the curve; GCV/AIV = great cardiac vein/anterior interventricular vein; LV = left ventricular; ROC = receiver operating characteristic. *Epicardium requiring pericardial access. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 5 The CARTO 3-dimensional electroanatomic mapping system (Pace Mapping Software, Biosense Webster) demonstrated the successful ablation site at the epicardial LV summit. The LV wall thickness of the successful ablation site was 11.6 mm. AP = anterior-posterior view; LAO = left anterior oblique views; LV = left ventricular. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 6 Computed tomographic image depicting the anatomy of the continuum between the aortic sinus of Valsalva and the LV summit. The LV summit is a triangular region of the LV epicardium with the apex at the bifurcation between the LAD and LCx coronary arteries, and the base formed by an arc connecting the first SP branch of the LAD with the LCx (white dotted line with arrows). The LV summit is bisected by the GCV (blue color vessel), which separates it into 2 regions. One section is closer to the apex of the triangle (blue dotted line), while a more lateral section is seen toward the base of the triangle (yellow dotted line). There was a close anatomical correlation between the LV summit, left cusp, and subvalvular area. GCV = great cardiac vein; LAD = left anterior descending; LCC = left coronary cusp; LCx = left circumflex; LV = left ventricular; RCC = right coronary cusp; SP = septal perforator. Heart Rhythm 2016 13, 111-121DOI: (10.1016/j.hrthm.2015.08.030) Copyright © 2016 Heart Rhythm Society Terms and Conditions