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Images and Case Reports in Arrhythmia and Electrophysiology

Left Ventricular Outflow Tract Tachycardia With Preferential Conduction and Multiple Exits

Takumi Yamada, MD; Michael Platonov, MD; H. Thomas McElderry, MD and G. Neal Kay, MD

From the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala.

Correspondence to Takumi Yamada, MD, PhD, Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd Ave S, Birmingham, AL 35294-0019. E-mail takumi-y@fb4.so-net.ne.jp

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 50-year-old man with idiopathic premature ventricular contractions (PVCs; PVC 1, Figure 1A) and ventricular tachycardias (VTs) was referred for catheter ablation. Activation and pace mapping were performed at multiple sites in the right and left ventricular outflow tracts (RVOT and LVOT) (Figure 1). Nonirrigated radiofrequency (RF) applications delivered in the left coronary cusp where pacing reproduced a perfect pace map failed to suppress PVCs but gave a slight change in the QRS morphology of the PVCs characterized by S waves in lead V6 (PVC 2, Figure 1B). VT with this altered QRS morphology was induced by programmed stimulation (VT 1, Figure 1B). Pacing in the distal great cardiac vein (GCV) reproduced a different QRS morphology (Figure 1D). During PVC 2, the earliest ventricular activation was observed at the aorto-mitral continuity (AMC) where pacing reproduced a perfect pace map (Figure 1B). However, nonirrigated RF applications at this site did not prevent the induction of multiple morphologies of VT with programmed stimulation (Figure 1). Those VT morphologies exhibited a fair match to the pace maps from the RVOT, GCV, and right coronary cusp (RCC) (VT 2, Figure 1C; VT 3, Figure 1D; and VT 4, Figure 1E, respectively). Gradual transition between 2 of those VT morphologies (VT 3 and VT 4) was observed, and the local ventricular activation in the GCV preceded the QRS onset during both of those VTs (Figure 2). The local ventricular . . . [Full Text of this Article]

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				T. Yamada, S. H. Litovsky, and G. N. Kay The Left Ventricular Ostium: An Anatomic Concept Relevant to Idiopathic Ventricular Arrhythmias Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 396 - 404. [Full Text] [PDF]