Related Experiment Video
Updated: May 8, 2026
Determination of Continuity Index Values in Atrial Fibrillation Ablation with Proactive Esophageal Cooling
Published on: April 19, 2024
Discrete prepotential as an indicator of successful ablation in patients with coronary cusp ventricular arrhythmia
Hitoshi Hachiya1, Yasuteru Yamauchi, Yoshito Iesaka
1Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Japan.
Insights
Identifying successful ablation sites for coronary cusp (CC) ventricular arrhythmia (VA) is crucial. A discrete prepotential, especially with a 50 ms activation time, can reliably indicate successful ablation sites in CC-VA.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Catheter ablation is a treatment for coronary cusp (CC) ventricular arrhythmia (VA).
- Reliable indicators for successful ablation sites in CC-VA are not well-established.
- Outflow tract-VA requires precise identification of ablation targets.
Purpose of the Study:
- To identify reliable indicators of successful radiofrequency catheter ablation sites for outflow tract-VA originating from the coronary cusps.
- To evaluate the diagnostic value of prepotentials recorded at the ablation site.
Main Methods:
- Retrospective analysis of 392 patients undergoing radiofrequency catheter ablation for outflow tract-VA.
- Identification of successful ablation sites in the left or right coronary cusp (CC).
- Analysis of electrophysiological signals, including prepotentials and activation times, at successful ablation sites.
Main Results:
- Successful ablation was achieved in 35 patients (8.9%), with sites located in the left or right CC.
- A discrete prepotential was observed in 9 of these 35 patients (26%), all of whom had successful ablation at the prepotential site.
- The activation time from the prepotential onset to QRS onset was 69±20 ms (range, 50-98 ms).
Conclusions:
- A discrete prepotential, particularly with an activation time of ≥50 ms, may serve as a reliable indicator of a successful ablation site for left and right CC-VA.
- This finding aids in improving the efficacy and precision of catheter ablation for CC-VA.
Background:
Although coronary cusp (CC) ventricular arrhythmia (VA) can be treated by catheter ablation, reliable indicators of successful ablation sites have not been fully identified.
Methods And Results:
This study comprised 392 patients undergoing radiofrequency catheter ablation for outflow tract-VA at 3 institutions from January 2007 to August 2012. The successful ablation site was on the left CC or right CC in 35 (8.9%) of the 392 patients. In 9 (26%) of these 35 patients, a discrete prepotential was recognized, 5 of whom had left CC-VAs and 4 of whom had right CC-VAs. Radiofrequency catheter ablation was successful at the site of the prepotential in all 9 of these patients. The duration of the isoelectric line between the end of the discrete prepotential and the onset of the ventricular electrogram was 27±13 ms. The time from onset of the discrete prepotential at the successful ablation site on the CC to the QRS onset (activation time) was 69±20 ms (range, 50-98 ms). Pace mapping was graded as excellent at the successful ablation site in only 1 patient. No discrete prepotential was recorded in any successful right outflow tract-VA ablation case in this study.
Conclusions:
A discrete prepotential was seen in 9 (26%) of 35 patients with CC-VA. In left and right CC-VA, the site of a discrete prepotential with ≥50 ms activation time may indicate a successful ablation site.
