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Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties

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Abstract

Purpose

There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD).

Methods

We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment.

Results

There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers.

Conclusions

In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.

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Funding

Taipei Veterans General Hospital (V102B-002, V102E7-003, V103C-042, V103C-126, V103E7-002, VGHUST103-G1-3-1, V104C-131, V104E7-003, VA105C-60), Ministry of Science and Technology (NSC 101-2911-I-008-001, NSC 102-2325-B-010-005, MOST 103-2314-B-075-062-MY3, MOST 104-2314-B-075-065-MY2), and Research Foundation of Cardiovascular Medicine (RFCM 100-02-011, 101-01-001, 104-01-009-01).

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Chung-Hsing Lin, Li-Wei Lo, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Ta-Chuan Tuan, Hung-Kai Huang, Cheng-Hung Chiang, Suresh Allamsetty, Jo-Nan Liao, Fa-Po Chung, Yao-Ting Chang, Chin-Yu Lin, Abigail Louise D. Te, Shinya Yamada, Rohit Walia, Yuan Hung & Shih-Ann Chen

  2. Division of Cardiology, Department of Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan

    Chung-Hsing Lin

  3. Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan

    Li-Wei Lo, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Yao-Ting Chang, Chin-Yu Lin & Shih-Ann Chen

  4. Division of Cardiology, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan

    Hung-Kai Huang

  5. Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Cheng-Hung Chiang

  6. Apollo Hospital, Visakhapatnam, Andhra Pradesh, India

    Suresh Allamsetty

  7. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan

    Shinya Yamada

  8. Bhagat Phool Singh Government Medical College, Sonipat, Haryana, India

    Rohit Walia

  9. Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Yuan Hung

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  1. Chung-Hsing Lin
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  2. Li-Wei Lo
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  3. Yenn-Jiang Lin
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  6. Ta-Chuan Tuan
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  7. Hung-Kai Huang
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  9. Suresh Allamsetty
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  10. Jo-Nan Liao
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  11. Fa-Po Chung
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  12. Yao-Ting Chang
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  13. Chin-Yu Lin
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  14. Abigail Louise D. Te
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  15. Shinya Yamada
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  16. Rohit Walia
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  17. Yuan Hung
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  18. Shih-Ann Chen
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Corresponding author

Correspondence to Shih-Ann Chen.

Ethics declarations

All patients gave written informed consent prior to the ablation procedures in accordance with institutional guidelines of the Taipei Veteran General Hospital. The study has been approved by the Institutional Review Board committee of Taipei Veterans General Hospital (IRB No: 2017-06-001 BC).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional Review Board committee of Taipei Veterans General Hospital (IRB No: 2017-06-001 BC).

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Lin, CH., Lo, LW., Lin, YJ. et al. Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties. J Interv Card Electrophysiol 52, 225–236 (2018). https://doi.org/10.1007/s10840-018-0350-2

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  • DOI: https://doi.org/10.1007/s10840-018-0350-2

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