Title

Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation

Publication Date

January 2015

Journal Title

Heart Rhythm

Abstract

BACKGROUND The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs). OBJECTIVE The purpose of this study was to identify the prevalence and effective mapping/ablation strategies for idiopathic VAs mapped to the CVS. METHODS Detailed activation and pace-mapping of the right ventricle (RV), Left ventricle (LV), CVS, and aortic cusps was performed, followed by attempted catheter ablation. RESULTS Forty-seven of 511 patients with non-scar-related VAs (21 males, age 55 15) had earliest activation in the CVS, 39 18 ms before QRS. Twenty-five (53%) were in the great cardiac vein, 19 (40%) in the anterior interventricular vein, and 3 (7%) in the middle cardiac vein. We ablated inside CVS in 32 patients (68%) at the earliest activation site, in 18 patients at an adjacent CVS site, and in 14 patients because of an inability to advance the catheter in 4, inadequate power delivery in 2, and for safer distance from the coronary artery in 8. Proximity to coronaries precluded ablation inside the CVS in the remaining 15 patients (32%), who underwent ablation from adjacent Left sinus of VaLsalva, RV or LV endocardium, or LV epicardium. Success was achieved in 17 of 18 (94%) ablated at the earliest CVS site and in 16 of 29 (55%) ablated at adjacent CVS or non-CVS sites. CONCLUSION Idiopathic VAs are occasionally (9%) linked to CVS. Although ablation at the earliest CVS site is effective, it is often (62%) precluded, mainly because of proximity to coronary arteries. Ablation at adjacent CVS and non-CVS sites can be successful in 55% of these anatomically challenging cases, for an overall ablation success rate of 70%.

Volume Number

12

Issue Number

6

Pages

1145-1153

Document Type

Article

EPub Date

2015/03/15

Facility

School of Medicine

Primary Department

Cardiology

PMID

WOS:000354821900011

DOI

10.1016/j.hrthm.2015.03.009

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