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Idiopathic premature ventricular contractions exhibiting preferential conduction within the aortic root
Takumi Yamada1, Yukihiko Yoshida, Yasuya Inden
1Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd Avenue S, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
Pacing and Clinical Electrophysiology : PACE
|October 7, 2009
Summary
Premature ventricular contractions (PVCs) originating from the aortic root can be challenging to locate. Ablation in the left coronary cusp was successful, suggesting variable activation patterns influence diagnosis.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Premature ventricular contractions (PVCs) are common arrhythmias.
- Aortic root ectopy can present diagnostic challenges.
- Electrophysiological testing is crucial for identifying arrhythmia origins.
Observation:
- A patient with frequent PVCs showed an excellent pace map from the right coronary cusp (RCC).
- Radiofrequency ablation at the RCC provided only transient PVC interruption.
- Successful ablation was achieved in the left coronary cusp, with earlier ventricular activation noted there during PVCs compared to the RCC.
Findings:
- Ventricular arrhythmias originating from the aortic root may exhibit variable activation patterns.
- Preferential conduction pathways might exist within the aortic root.
- Electrocardiographic algorithms and pace mapping may have limited reliability for aortic root VAs.
Implications:
- Understanding variable conduction in the aortic root is key for successful ablation.
- New diagnostic strategies may be needed for complex ventricular arrhythmias.
- This case highlights the importance of detailed electrophysiological mapping in challenging cases.
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