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Outflow tract ventricular arrhythmias

Electrocardiographic features in relation to mapping and ablation

Ventrikuläre Ausflusstraktarrhythmien

Elektrokardiographische Charakteristika in Bezug auf Mapping und Ablation

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Abstract

Ventricular arrhythmia arising from the outflow tracts can manifest itself as frequent premature ventricular complexes (PVCs), salvos of ventricular tachycardia (VT), and/or sustained VT. It is amenable to management with medication and catheter ablation without need for an intracardiac defibrillator. The electrocardiogram (ECG) is a crucial tool in the management of these patients as it is can help localize the site of origin, thereby helping guide the electrophysiologist. An appreciation of the unique anatomy of the outflow tracts as well as their relationships with the surrounding structures is essential in interpreting the ECG. In this review, we examine the ECG features of the various outflow tract arrhythmia morphologies with a focus on anatomy and provide an approach to the ablation of these abnormal rhythms.

Zusammenfassung

Die ventrikuläre Arrhythmie aus einem Ausflusstrakt kann sich als häufige vorzeitige ventrikuläre Komplexe (PVC), Salven von ventrikulären Tachykardien (VT) und/oder anhaltende VT manifestieren. Sie ist mittels medikamentöser Therapie und Katheterablation behandelbar, ohne dass ein intrakardialer Defibrillator notwendig ist. Das Elektrokardiogramm (EKG) ist ein wichtiges Instrument bei der Behandlung dieser Patienten, da es bei der Lokalisierung des Ursprungsorts helfen kann und damit dem Elektrophysiologen leitende Hilfestellung bietet. Die Beachtung der einzigartigen Anatomie der Ausflusstrakte sowie ihrer Beziehung zu den umliegenden Strukturen ist für die Interpretation des EKG essenziell. In diesem Review untersuchen wir die EKG-Charakteristika der unterschiedlichen Ausflusstraktarrhythmie-Morphologien mit dem Fokus auf die Anatomie und stellen ein Verfahren für die Ablation dieser Arrhythmien vor.

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Acknowledgements

The authors acknowledge the efforts of Margot Potts and Jennifer Mears in formatting and creating this manuscript with its figures.

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Mayo Clinic, 55901, Rochester, MN, USA

    Deepak Padmanabhan, Alan Sugrue, Prakriti Gaba &  Samuel J Asirvatham

Authors
  1. Deepak Padmanabhan
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  2. Alan Sugrue
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  3. Prakriti Gaba
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  4. Samuel J Asirvatham
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Corresponding author

Correspondence to Samuel J Asirvatham.

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Conflict of interest

D. Padmanabhan, A. Sugrue, P. Gaba and S.J. Asirvatham declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Video 1 Reconstructed computed tomographic image showing the anatomy of the outflow tracts

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Padmanabhan, D., Sugrue, A., Gaba, P. et al. Outflow tract ventricular arrhythmias. Herzschr Elektrophys 28, 177–186 (2017). https://doi.org/10.1007/s00399-017-0507-1

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