Advertisement

Journal of Interventional Cardiac Electrophysiology

, Volume 49, Issue 3, pp 291–297 | Cite as

Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

  • Hung-Kai Huang
  • Fa-Po Chung
  • Yenn-Jiang LinEmail author
  • Shih-Lin Chang
  • Li-Wei Lo
  • Yu-Feng Hu
  • Ta-Chuan Tuan
  • Tze-Fan Chao
  • Jo-Nan Liao
  • Chin-Yu Lin
  • Yao-Ting Chang
  • Abigail Louise D. Te
  • Shinya Yamada
  • Shih-Ann Chen
Article
  • 323 Downloads

Abstract

Purpose

Differentiation between idiopathic left posterior fascicular ventricular arrhythmias (LPF-VAs) and posterior papillary muscle (PPM) VAs is of clinical value. This study aimed to develop an algorithm to distinguish PPM-VAs from LPF-VAs.

Methods

This study enrolled 73 consecutive cases, including 31 with PPM-VAs and 42 with LPF-VAs, undergoing successful ablation by using 3D mapping and intracardiac echography to confirm the origin of the VAs. Electrocardiographic and electrophysiological parameters were compared between two groups.

Results

The 12-lead electrocardiography of the PPM-VAs was characterized by a longer QRS duration than that in LPF-VAs (154.4 ± 14.5 vs. 132.3 ± 13.1 ms, P < 0.001). A QRS duration ≥133 ms was observed in all patients (100%) with PPM-VAs and 13/42 (31.0%) patients with LPF-VAs. The conduction duration from the earliest left ventricular activation site of the VA to the proximal right bundle branch (VA-RBB) was longer in patients with PPM-VAs than LPF-VAs (51.3 ± 12.2 vs. 23.6 ± 7.7 ms, P < 0.001). Based on the ROC analysis, a VA-RBB >36 ms was recognized in 28/31 patients with PPM-VAs (90.3%) and 2/42 with LPF-VAs (4.8%). An algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of a VA-RBB of >36 ms could yield a sensitivity of 90.3% and specificity of 100% for discriminating PPM-VAs from LPF-VAs.

Conclusions

The novel algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of the VA-RBB of >36 ms could be useful in differentiating PPM-VAs from LPF-VAs.

Keywords

Left posterior fascicular Posterior papillary muscle Right bundle branch Ventricular arrhythmia 

Abbreviations

ECG

Electrocardiography

PPM

Posterior papillary muscle

LPF

Left posterior fascicular

RBB

Right bundle branch

LV

Left ventricle

VA

Ventricular arrhythmia

VT

Ventricular tachycardia

Notes

Acknowledgments

This work was supported by the Center for Dynamical Biomarkers and Translational Medicine, Ministry of Science and Technology (Grant No. MOST104-2314-B-075-089-MY3, MOST 103-2911-I-008-001, MOST103-2314-B-075 -089 -MY3, NSC 102-2314-B-010-056-MY2), Research Foundation of Cardiovascular Medicine (Grant No. RFCM 104-01-012, RFCM 105-02-028, RFCM 105-02-008, and RFCM 105-02-028), TVGH-NTUH Joint Research Program (Grant No. VGHUST105-G7-4-1), Szu-Yuan Research Foundation of Internal Medicine (Grant No. 106003), TVGH-NTUH Joint Research Program (Grant No. VN103-04) and Taipei Veterans General Hospital (Grant No. V103C-042, V104B-018, V104E7-001, V104C-109, V105B-014, V105C-122, V105C-116, V106C-158 and V106B-010).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Nogami A. Purkinje-related arrhythmias part I: monomorphic ventricular tachycardias. Pacing and clinical electrophysiology: PACE. 2011;34(5):624–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Doppalapudi H, Yamada T, McElderry HT, Plumb VJ, Epstein AE, Kay GN. Ventricular tachycardia originating from the posterior papillary muscle in the left ventricle: a distinct clinical syndrome. Circulation Arrhythmia and electrophysiology. 2008;1(1):23–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Good E, Desjardins B, Jongnarangsin K, Oral H, Chugh A, Ebinger M, et al. Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: a comparison with fascicular arrhythmias. Heart Rhythm. 2008;5(11):1530–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Bogun F, Desjardins B, Crawford T, Good E, Jongnarangsin K, Oral H, et al. Post-infarction ventricular arrhythmias originating in papillary muscles. J Am Coll Cardiol. 2008;51(18):1794–802.CrossRefPubMedGoogle Scholar
  5. 5.
    Yamada T, Doppalapudi H, McElderry HT, Okada T, Murakami Y, Inden Y, et al. Idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 2010;21(1):62–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Yokokawa M, Good E, Desjardins B, Crawford T, Jongnarangsin K, Chugh A, et al. Predictors of successful catheter ablation of ventricular arrhythmias arising from the papillary muscles. Heart Rhythm. 2010;7(11):1654–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yamada T, Doppalapudi H, McElderry HT, Okada T, Murakami Y, Inden Y, et al. Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: relevance for catheter ablation. Circ Arrhythm Electrophysiol. 2010;3(4):324–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Ban JE, Lee HS, Lee DI, Park HC, Park JS, Nagamoto Y, et al. Electrophysiological characteristics related to outcome after catheter ablation of idiopathic ventricular arrhythmia originating from the papillary muscle in the left ventricle. Korean Circ J. 2013;43(12):811–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lopera G, Stevenson WG, Soejima K, Maisel WH, Koplan B, Sapp JL, et al. Identification and ablation of three types of ventricular tachycardia involving the his-purkinje system in patients with heart disease. J Cardiovasc Electrophysiol. 2004;15(1):52–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Nogami A, Naito S, Tada H, Taniguchi K, Okamoto Y, Nishimura S, et al. Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Am Coll Cardiol. 2000;36(3):811–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Anderson RH, Ho SY. The morphology of the specialized atrioventricular junctional area: the evolution of understanding. Pacing Clin Electrophysiol. 2002;25(6):957–66.CrossRefPubMedGoogle Scholar
  12. 12.
    Dixit S, Gerstenfeld EP, Lin D, Callans DJ, Hsia HH, Nayak HM, et al. Identification of distinct electrocardiographic patterns from the basal left ventricle: distinguishing medial and lateral sites of origin in patients with idiopathic ventricular tachycardia. Heart Rhythm. 2005;2(5):485–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Hung-Kai Huang
    • 1
    • 2
  • Fa-Po Chung
    • 1
    • 3
  • Yenn-Jiang Lin
    • 1
    • 3
    Email author
  • Shih-Lin Chang
    • 1
    • 3
  • Li-Wei Lo
    • 1
    • 3
  • Yu-Feng Hu
    • 1
    • 3
  • Ta-Chuan Tuan
    • 1
    • 3
  • Tze-Fan Chao
    • 1
    • 3
  • Jo-Nan Liao
    • 1
    • 3
  • Chin-Yu Lin
    • 1
    • 3
  • Yao-Ting Chang
    • 1
    • 3
  • Abigail Louise D. Te
    • 1
    • 3
  • Shinya Yamada
    • 1
    • 3
  • Shih-Ann Chen
    • 1
    • 3
  1. 1.Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Division of Cardiology, Department of MedicineChanghua Christian HospitalChanghuaTaiwan
  3. 3.Department of Medicine, Faculty of MedicineNational Yang-Ming UniversityTaipeiTaiwan

Personalised recommendations