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Epicardial catheter ablation of idiopathic ventricular arrhythmias originating from uncommon epicardial sites

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Abstract

Purpose

Idiopathic epicardial ventricular arrhythmias (VAs) are clustered in the areas of the summit and crux. This study was to report a group of idiopathic epicardial VAs remote from the summit and crux areas.

Methods

In total, 9 patients (6 males, mean age 32 ± 13 years) were enrolled. The locations were identified by epicardial mapping and ablation. The electrocardiographic and electrophysiological characteristics were compared to those of 9 patients who had VAs ablated at the opposite endocardial site.

Results

VAs were identified at the epicardium, with 4 patients had VAs located at the inferior wall, one at the anterior wall, one at the apex and 3 patients had VAs at the lateral wall. A “QS” type at the location-related leads was the only identified surface electrocardiogram indication suggesting epicardial origin (compared to that of the controls, 100% vs 0%, p<0.001). Endocardial and epicardial mapping revealed pre-maturities of −11 ± 4 ms and −25 ± 8 ms, respectively (VS. −28 ± 8 ms revealed by endocardial mapping in control patients, p<0.001 and p=0.389, respectively). All of the study cases demonstrated an “rS” pattern in the endocardial unipolar electrogram. Acute and long-term successful ablation (a median of 11 months of follow-up) was achieved in all patients without complications.

Conclusions

A distinct group of idiopathic VAs remote from the summit and crux areas warranting ablation by a subxiphoid approach were identified. Morphological ECG features of a “QS” type among the location-related grouped leads combined with the mapping findings helped in the identification of the epicardial site of origin.

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Author notes

  1. Weizhu Ju and Jinlin Zhang are contributed equally

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China

    Weizhu Ju, Linsheng Shi, Kai Gu, Ming Chu, Hongwu Chen, Gang Yang, Mingfang Li, Hailei Liu, Fengxiang Zhang, Bing Yang & Minglong Chen

  2. Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China

    Jinlin Zhang

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  1. Weizhu Ju
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  2. Jinlin Zhang
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  3. Linsheng Shi
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  4. Kai Gu
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  5. Ming Chu
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  11. Bing Yang
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  12. Minglong Chen
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Correspondence to Minglong Chen.

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Ju, W., Zhang, J., Shi, L. et al. Epicardial catheter ablation of idiopathic ventricular arrhythmias originating from uncommon epicardial sites. J Interv Card Electrophysiol 66, 63–72 (2023). https://doi.org/10.1007/s10840-022-01149-5

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  • DOI: https://doi.org/10.1007/s10840-022-01149-5

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