Idiopathic ventricular arrhythmia originating from the vicinity of lateral tricuspid annulus: The precise origin and
Yang Yang1, Mengmeng Li1, Chenxi Jiang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Insights
Idiopathic ventricular arrhythmias (VAs) originating near the lateral tricuspid annulus (TA) arise from a subvalvular muscular bundle. A reverse catheter technique is necessary to precisely ablate these lateral TA-VAs.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Previous studies have described electrocardiographic and electrophysiological properties of ventricular arrhythmias (VAs) near the lateral tricuspid annulus (TA).
- However, the precise anatomical origin of these lateral TA-VAs remains unaddressed.
Purpose of the Study:
- To precisely identify the origin of lateral TA-VAs.
- To describe the relevant cardiac anatomy associated with these arrhythmias.
Main Methods:
- Analysis of consecutive patients with idiopathic lateral TA-VAs.
- Utilized a three-dimensional mapping system integrated with intracardiac echocardiography (ICE) for anatomical reconstruction, mapping, and ablation.
Main Results:
- Identified a subvalvular enfoldment structure along the lateral TA in 63 patients, containing muscular bundles in all cases.
- The earliest activation site for VAs was located at the valvular end of these muscular bundles in 80.9% of patients.
- Successful ablation was achieved using a reverse catheter technique, with VAs eliminated in an average of 4 ± 2 seconds.
Conclusions:
- The ventricular side of the lateral TA features a subvalvular enfoldment rich in muscular bundles, serving as the origin for most lateral TA-VAs.
- A reverse catheter technique is essential for accessing and ablating these specific arrhythmia origins.
Background:
Although the electrocardiographic and electrophysiological properties of ventricular arrhythmias (VAs) from the vicinity of the lateral tricuspid annulus (TA) have been reported in previous studies, their precise site of origin have not been addressed.
Objective:
The purpose of this study was to describe the precise origin of lateral TA-VA and the relevant anatomy.
Methods:
Consecutive patients with idiopathic lateral TA-VAs were reviewed and analyzed. Three-dimensional mapping system combined with intracardiac echocardiography (ICE) was used for anatomic reconstruction, mapping, and ablation.
Results:
During the study period, 63 patients with lateral TA-VAs were included. Under ICE view, a prominent enfoldment structure was observed under the valve along the lateral TA. The muscular bundle was documented in all patients (100%) within the subvalvular enfoldment with an average number and diameter of 4 ± 2 and 4.10 ± 0.73 mm, respectively. Initial ablation was attempted via the anterograde approach in 15 patients but succeeded in none. To reach the ventricular side of the TA, the catheter needed to enter the ventricular chamber and retroflexed toward the atrial side with a reverse curve. The earliest activation site was found at the valvular end of muscular bundles in 51 of the 63 patients (80.9%) with a local activation time of -26.78 ± 4.63 ms. The VAs were eliminated after an average of 4 ± 2 seconds of ablation.
Conclusion:
The ventricular side adjacent to the lateral TA exhibits a subvalvular enfoldment-like structure, which is rich in muscular bundles and serves as the origin of TA-VAs in most patients. To reach the origins, a reverse technique is required.
More Related Videos
Related Concept Videos
01:28Mechanism of Cardiac Arrhythmias
01:16ECG Interpretation of Arrhythmias I: Sinus Arrhythmias
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism,...
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:16Chambers of the Heart
Deoxygenated blood from the body is received in the right...
01:19Conduction System of the Heart
The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...