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Updated: Jun 16, 2026

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
06:57

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

Published on: January 31, 2019

Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left

Rupa Bala1, Fermin C Garcia, Mathew D Hutchinson

  • 1Electrophysiology Section, Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

Heart Rhythm
|January 26, 2010
PubMed

Insights

Ventricular arrhythmias from the right coronary cusp-left coronary cusp (RCC-LCC) commissure are common. These arrhythmias exhibit a distinct QS morphology in lead V(1) and often show late potentials at the ablation site.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Anatomy

Background:

  • Ventricular arrhythmias frequently originate from the aortic sinus of Valsalva.
  • The specific characteristics of arrhythmias from the right coronary cusp-left coronary cusp (RCC-LCC) commissure require further elucidation.

Purpose of the Study:

  • To identify the distinct anatomical and electrocardiographic characteristics of ventricular arrhythmias originating from the RCC-LCC commissure.
  • To compare these characteristics with arrhythmias from other aortic cusp regions.

Main Methods:

  • Utilized intracardiac echocardiography and electroanatomic mapping in 37 patients with aortic cusp ventricular arrhythmias.
  • Defined coronary cusp anatomy and catheter positions.
  • Compared arrhythmias from the RCC-LCC commissure with those from other aortic cusp sites.

Main Results:

  • 51% of ventricular arrhythmias originated from the RCC-LCC commissure.
  • A QS morphology in lead V(1) with notching was significantly more common in RCC-LCC arrhythmias (15/19) compared to other sites (2/18).
  • Late potentials in sinus rhythm at the earliest activation site were observed in 13/19 RCC-LCC arrhythmias versus 1/18 from other sites. Successful ablation was above the aortic valve plane in 79% of RCC-LCC cases.

Conclusions:

  • Ventricular arrhythmias from the RCC-LCC aortic cusp are prevalent.
  • These arrhythmias are characterized by QS morphology in lead V(1) with precordial transition at V(3).
  • Successful ablation sites typically exhibit late potentials in sinus rhythm.
Abstract

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