Ventricular Arrhythmias near the Distal Great Cardiac Vein: A Challenging Arrhythmia for Ablation
Background—Catheter ablation (CA) for ventricular arrhythmia (VA) near the distal great cardiac vein (GCV) is often challenging and data are limited.
Methods and Results—Analysis was performed of 30 patients (19 male; age 52.8±15.5 years) who underwent CA for focal VA (11 ventricular tachycardia, 19 premature contractions) with early activation in the GCV (36.7±8.0 ms pre-QRS). Angiography in 27 patients showed earliest GCV site within 5 mm of a coronary artery in 20 (74%). Ablation was performed in the GCV in 15 patients and abolished VA in 8. Ablation was attempted at adjacent non-GCV sites in 19 patients and abolished VA in 5 patients (4 from the left ventricular endocardium and 1 from the left coronary cusp); all success had VA with an initial r wave in lead I and activation ≤7 ms after the GCV (GCV-nonGCV interval). In 13 patients percutaneous epicardial mapping was performed, but due to adjacent coronaries only 2 received radiofrequency application with VA elimination in 1. Surgical cryoablation was performed in 3 patients and abolished VA in 2. Overall acute success was achieved in 16 (53%) patients. After a median of 2.8 months, 13 patients remained free of VA. Major complications occurred in 4 patients including coronary injury requiring stenting.
Conclusions—Ablation for this arrhythmia is challenging and often limited by the adjacent coronary vessels. Success of anatomically guided endocardial ablation may be identified by a short GCV-nonGCV interval and r wave in lead I.
- Received February 23, 2014.
- Revision received June 17, 2014.
- Accepted June 23, 2014.