QRS complex maximum deflection index in aortic cusp premature ventricular complexes

Area of Science:

• Cardiac Electrophysiology
• Interventional Cardiology
• Arrhythmia Management

Background:

• Premature ventricular contractions (PVCs) can arise from challenging anatomical locations, including the aortic cusps.
• Accurate identification of PVC origin is crucial for successful catheter ablation.
• The Myocardial Dysfunction Index (MDI) is a parameter used in analyzing ventricular arrhythmias.

Purpose of the Study:

• To evaluate the efficacy of catheter ablation for PVCs originating in the aortic cusps.
• To assess the utility of the Myocardial Dysfunction Index (MDI) in identifying PVCs originating from the aortic cusps.

Main Methods:

• Retrospective review of 185 PVC catheter ablation cases.
• Identification of 17 cases with successful ablation of PVCs originating in the aortic cusps.
• Measurement and analysis of the Myocardial Dysfunction Index (MDI) in these cases.

Main Results:

• Successful ablation was achieved in 17 out of 185 PVC cases (9.2%) originating in the aortic cusps.
• The MDI measured 0.53 ± 0.10 (median 0.50), with 100% of cases showing MDI > 0.40 and 41% showing MDI > 0.55.
• Pseudo-delta wave was absent in all but one PVC, suggesting its limited utility in this specific cohort.

Conclusions:

• Catheter ablation is a viable option for treating PVCs originating in the aortic cusps.
• An MDI value around 0.55 is indicative of PVC origin in the aortic cusps, necessitating consideration alongside epicardial origins.
• The MDI is a valuable tool for differentiating PVC origins in the aortic cusps.