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Electrocardiographic features, mapping and ablation of idiopathic outflow tract ventricular arrhythmias

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Abstract

Purpose

Idiopathic outflow tract ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. These arrhythmias have focal origin and display characteristic electrocardiographic features. The purpose of this article is to review the state of the art of diagnosis and treatment of idiopathic outflow tract ventricular arrhythmias.

Methods

We systematically reviewed scientific literature about idiopathic outflow tract ventricular arrhythmias selecting the most relevant papers on this topic.

Results

The right ventricle outflow tract is the most common site of origin for outflow tract ventricular arrhythmias, but also left ventricle outflow tract can harbour these arrhythmias. Outflow tract ventricular arrhythmias are generally benign and may require treatment if they are symptomatic, incessant or give rise to cardiomyopathy. Radiofrequency catheter ablation is an effective and safe therapeutic strategy. A successful procedure requires a thorough preoperative analysis of the 12-lead electrocardiogram of the spontaneous arrhythmia combined with a detailed electroanatomical mapping and intracardiac echocardiography.

Conclusions

Idiopathic outflow tract arrhythmias are frequent in daily clinical practice and can be successfully eliminated through discrete radiofrequency catheter ablation with low rates of complications.

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Abbreviations

OT:

outflow tract

VA:

ventricular arrhythmia

RVOT:

right ventricle outflow tract

LVOT:

left ventricle outflow tract

RFCA:

radiofrequency catheter ablation

PVC:

premature ventricular contraction

LBBB:

left bundle branch block

RBBB:

right bundle branch block

ECG:

electrocardiogram

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Author notes

  1. Carlo Lavalle and Marco V. Mariani contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy

    Carlo Lavalle

  2. Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy

    Marco V. Mariani, Agostino Piro, Martina Straito, Paolo Severino & Francesco Fedele

  3. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Domenico G. Della Rocca

  4. Department of Cardiology, Luigi Sacco Hospital, Milan, Italy

    Giovanni B. Forleo

  5. Department of Cardiology, Montefiore Medical Center, New York, NY, USA

    Jorge Romero & Luigi Di Biase

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  1. Carlo Lavalle
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Correspondence to Carlo Lavalle.

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Lavalle, C., Mariani, M.V., Piro, A. et al. Electrocardiographic features, mapping and ablation of idiopathic outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 57, 207–218 (2020). https://doi.org/10.1007/s10840-019-00617-9

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