Epicardial Outflow Tract Ventricular Tachycardia: Distal Great Cardiac Vein and Coronary Cusp Origin
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概要
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The origin of outflow tract ventricular arrhythmia (OT-VA) can be predicted by ECG analysis. Recently, we devised a method to identify an epicardial OT-VA using the peak deflection index (PDI) in an inferior ECG lead. We will present our method of epicardial OT-VA identification and introduce how we determine the ablation site. <B>Methods:</B> An epicardial origin (10[14%] of the 70 patients) indicates that the successful ablation site of the OT-VA was in the distal great cardiac vein (GCV) (n=3) or on the coronary cusps (n=7). PDI is determined in the inferior lead presenting the tallest R wave by dividing the time from QRS onset to peak QRS deflection by total QRS duration. <B>Results:</B> A PDI of >0.6 predicted epicardial cases with a 90% sensitivity and a 95% specificity. In the 7 patients with coronary cusp ventricular arrhythmia (CC-VA), a discrete pre-potential (DPP) was recorded in 4 patients (57%). The DPP recorded at the successful ablation site on the coronary cusp preceded QRS onset by 63±16 ms (range, 50–84 ms). In those patients, excellent pace mapping was not always necessary. <B>Conclusions:</B> A PDI of >0.6 can be predictive of cases of epicardial OT-VA ablation in which the OT-VA origin is the distal GCV or the coronary cusps. In CC-VA, a DPP with activation time of ≥50 ms may be an indicator of successful ablation.
- 日本不整脈学会の論文
著者
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HIRAO Kenzo
Heart Rhythm Center, Tokyo Medical and Dental University
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Hachiya Hitoshi
Heart Rhythm Center, Tokyo Medical and Dental University
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