creators_name: Tada, Hiroshi editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-04-16 lastmod: 2011-03-11 08:55:56 metadata_visibility: show title: Idiopathic Epicardial Ventricular Arrhythmias: Diagnosis and Ablation Technique from the Aortic Sinus of Valsalva ispublished: pub subjects: ipej full_text_status: public keywords: Ventricular tachycardia; left sinus of Valsalva; potential; premature ventricular contraction; catheter ablation, tissue tracking imaging. abstract: Idiopathic outflow tract arrhythmias (ventricular tachycardias or symptomatic premature ventricular contractions; OT-VT/PVCs) can originate from the left ventricular (LV) epicardium (Epi-VT/PVCs), and radiofrequency (RF) energy applications from the aortic sinus of Valsalva can eliminate Epi-VT/PVCs in selected patients. Among the various ECG findings, the R-wave duration index and R/S amplitude index in leads V1 or V2 are useful for identifying Epi-VT/PVCs, and the Q-wave ratio of leads aVL to aVR and S-wave amplitude in lead V1 are useful for differentiating between an Epi-VT/PVC originating from the LV epicardium remote from the left sinus of Valsalva (LSV) and that from the LSV. Tissue tracking imaging is a promising modality for identifying the origin of OT-VT/PVCs and for differentiating between an Epi-VT/PVC originating from the LV epicardium remote from the LSV and that from the LSV. If the origin of the Epi-VT/PVC is identified within the LSV, coronary and aortic angiography should be performed to assess the anatomic relationships between the Epi-VT/PVC origin and coronary arteries and aortic valve before the RF energy delivery. To avoid potential complications, RF ablation should be performed at the LSV using a maximum power of 35 watts and maximum temperature of 55°C. Epicardial mapping through the coronary venous system and the presence of potentials recorded from the ablation site within the LSV and their changes before and after the RF energy applications may be useful for diagnosing Epi-VT/PVCs or predicting a successful catheter ablation from the LSV. date: 2005-04 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 5 number: 2 publisher: Indian Pacing and Electrophysiology Group pagerange: 96-105 refereed: TRUE referencetext: 1. Coggins DL, Lee RJ, Sweeney J, Chein WW, Van Hare G, Epstein L, Gonzalez R, Griffin JC, Lesh MD, Scheinman MM. Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994;23:1333-1341. 2. Daoud E, Morady F. Catheter ablation of ventricular tachycardia: Curr Opin Cardiol. 1995;10:21-25. 3. Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K. Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation 1998;98:1525-1533. 4. Zhu DW, Maloney JD, Simmons TW, Nitta J, Fitzgerald DM, Trohman RG, Khoury DS, Saliba W, Belco KM, Rizo-Patron C, Pinski SL. Radiofrequency catheter ablation for management of symptomatic ventricular ectopic activity. J Am Coll Cardiol 1995;26:843-849. 5. Rodriguez LM, Smeets JL, Timmermans C, Wellens HJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol 1997;79:309-314. 6. Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Hoshizaki H, Miyamori I, Oshima S, Taniguchi K, Nogami A. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 2003;14:1280-1286. 7. Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S, Niebauer M, Saliba W, Chung M, Tchou P, Natale A. Ventricular tachycardias arising from the aortic sinus of Valsalva: An under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 2001;37:1408-1414. 8. Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, Burns M, Antz M, Ernst S, Cappato R, Kuck KH. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: Electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002;39:500-508. 9. Hachiya H, Aonuma K, Yamauchi Y, Igawa M, Nogami A, Iesaka Y. How to diagnose , locate, and ablate coronary cusp ventricular tachycardia. J Cardiocasc Electrophysiol 2002;13:551-556. 10. Shimoike E, Ohnishi Y, Ueda N, Maruyama T, Kaji Y. Radiofrequency catheter ablation of left ventricular outflow tract tachycardia from the coronary cusp: A new approach to the tachycardia focus. J Cardiovasc Electrophysiol 1999;10:1005-1009. 11. Sadanaga T, Saeki K, Yoshimoto T, Funatsu Y, Miyazaki T. Repetitive monomorphic ventricular tachycardia of left coronary cusp origin. Pacing Clin Electrophysiol 1999;22:1553-1556. 12. Nogami A. Idiopathic left ventricular tachycardia: assessment and treatment. Card Electrophysiol Rev 2002;6:448-457. 13. Tada H, Nogami A, Naito S, Fukazawa H, Horie Y, Kubota S, Okamoto Y, Hoshizaki H, Oshima S, Taniguchi K. Left ventricular epicardial outflow tract tachycardia: A new distinct subgroup of outflow tract tachycardia. Jpn Circ J 2001;65:723-730. 14. de Paola AA, Melo WD, Tavora MZ, Martinez EE: Angiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins. Heart 1998;79:59-63. 15. Stellbrink C, Diem B, Schauerte P, Ziegert K, Hanrath P: Transcoronary venous radiofrequency catheter ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 1997;8:916-921. 16. Schweikert RA, Saliba WI, Tomassoni G, Marrouche NF, Cole CR, Dresing TJ, Tchou PJ, Bash D, Beheiry S, Lam C, Kanagaratnam L, Natale A. Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations. Circulation 2003;108:1329-1335. 17. Inden Y, Usui A, Akahoshi M, Yanagawa T, Hirai M, Hayashi H. Influence of radiofrequency ablation of Valsalva’s sinus: a new approach to idiopathic ventricular tachycardia originating from the left ventricle adjacent to Valsalva’s sinus. (Abstract) Pacing Clin Electrophysiol 1997;20[Pt. II]:1205. 18. Freidman PL, Stevenson WG, Bittl JA, Simon DI, Kay GN, Lerman BB, Miles WM. Left main artery occlusion during radiofrequency catheter ablation of idiopathic outflow tract ventricular tachycardia. (Abstract) Pacing Clin Electrophysiol 1997;20[Pt. II]:1184. 19. Callans DJ, Menz V, Schwartzman D, Gottlieb CD, Marchlinski FE. Repetitive monomorphic tachycardia from the left ventricular outflow tract: Electrocardiographic patterns consistent with a left ventricular site of origin. J Am Coll Cardiol 1997;29:1023-1027. 20. Tada H, Hiratsuji T, Naito S, Kurosaki K, Ueda M, Ito S, Shinbo G, Hoshizaki H, Oshima S, Nogami A, Taniguchi K. Prevalence and characteristics of idiopathic outflow tract tachycardia with QRS alteration following catheter ablation requiring additional radiofrequency ablation at a different point in the outflow tract. Pacing Clin Electrophysiol 2004;27:1240-1249. 21. Tada H, Toide H, Naito S, Ito S, Kurosaki K, Kobayashi Y, Miyaji K, Yamada M, Oshima S, Nogami A, Taniguchi K. Tissue tracking imaging as a new modality for identifying the origin of idiopathic ventricular arrhythmias. Am J Cardiol 2005;95: 660-664. 22. Borges AC, Kivelitz D, Walde T, Reibis RK, Grohmann A, Panda A, Wernecke KD, Rutsch W, Hamm B, Baumann G. Apical tissue tracking echocardiography for characterization of regional left ventricular function: comparison with magnetic resonance imaging in patients after myocardial infarction. J Am Soc Echocardiogr 2003;16:254-262. 23. Pan C, Hoffmann R, Kuhl H, Severin E, Franke A, Hanrath P. Tissue tracking allows rapid and accurate visual evaluation of left ventricular function. Eur J Echocardiogr 2001;2:197-202. 24. Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Shinbo G, Oshima S, Nogami A, Taniguchi K. Simultaneous mapping in the left sinus of Valsalva and coronary venous system predicts successful catheter ablation from the left sinus of Valsalva. Pacing Clin Electrophysiol 2005; 28: S150-S154. 25. Yamauchi Y, Aonuma K, Hachiya H, Yokoyama Y, Sekiguchi Y, Sato A, Okada H, Suzuki A, Nogami A, Iesaka Y. Significance of presystolic bipolar potential in radiofrequency catheter ablation for repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp. (Abstract) Circulation 2002;106 (Suppl. II):II-341. 26. Tada H, Naito S, Ito S, Kurosaki K, Ueda M, Shinbo G, Hoshizaki H, Oshima S, Taniguchi K, Nogami A. Significance of two potentials for successful catheter ablation from the left sinus of Valsalva in left ventricular epicardial tachycardia. Pacing Clin Electrophysiol 2004;27:1053-1059. citation: Tada, Hiroshi (2005) Idiopathic Epicardial Ventricular Arrhythmias: Diagnosis and Ablation Technique from the Aortic Sinus of Valsalva. [Journal (Paginated)] document_url: http://cogprints.org/4222/1/tada.htm document_url: http://cogprints.org/4222/2/tada.pdf