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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation of Arrhythmias Originating From the Left Ventricular Outflow Tract

Jim W Cheung1, Robert H Anderson2, Steven M Markowitz1

  • 1Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.

JACC. Clinical Electrophysiology
|January 26, 2019
PubMed

Insights

Understanding the complex anatomy of the left ventricular outflow tract (LVOT) is crucial for treating arrhythmias. Detailed knowledge of its relationship with surrounding structures improves ablation success rates for challenging LVOT arrhythmias.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Anatomy

Background:

  • The left ventricular outflow tract (LVOT) is a common origin for arrhythmias in patients with and without heart disease.
  • Successful treatment of LVOT arrhythmias requires a thorough understanding of its complex anatomical relationships.

Purpose of the Study:

  • To elucidate the critical anatomical features of the LVOT and adjacent structures.
  • To highlight the implications of LVOT anatomy for arrhythmia mapping and ablation strategies.

Main Methods:

  • Review of anatomical relationships between the LVOT, aortic valve, sinuses of Valsalva, coronary arteries, and ventricular myocardium.
  • Discussion of challenges posed by epicardial fat and intramural myocardial tissue in the LVOT.

Main Results:

  • The insertion of aortic valvar leaflets and myocardial tissue within the aortic sinuses impacts ablation strategies.
  • Epicardial fat, coronary arteries, and myocardium present unique challenges for targeting LVOT arrhythmias, particularly at the LV summit.

Conclusions:

  • Advances in ablation techniques, coupled with a comprehensive understanding of LVOT anatomy, enhance success rates for treating difficult LVOT arrhythmias.
  • Targeting arrhythmias originating from the LVOT requires detailed anatomical knowledge for effective catheter ablation.

Keywords:
aortic rootaortic sinuses of Valsalvacatheter ablationleft ventricular outflow tractleft ventricular summit

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