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Heart and Vessels

, Volume 34, Issue 1, pp 74–83 | Cite as

Evaluation of the pulmonary artery potential using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography

  • Masayuki Takahashi
  • Hisashi YokoshikiEmail author
  • Hirofumi Mitsuyama
  • Taro Tenma
  • Masaya Watanabe
  • Rui Kamada
  • Ryo Sasaki
  • Yuki Chiba
  • Motoki Maeno
  • Toshihisa Anzai
Original Article
  • 88 Downloads

Abstract

Prolongation of the pulmonary artery potentials (PAPs) in response to short coupling intervals was related to polymorphic QRS configurations during the ventricular tachycardia originating above the pulmonary valve (PA-VT). This prospective study was aimed to investigate the mechanisms of polymorphic changes during the PA-VT. We performed the mapping above the pulmonary valve using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography in 9 consecutive patients with outflow tract arrhythmias undergoing catheter ablation (UMIN ID: UMIN000021682). The location of successful ablation was right ventricular outflow tract (RVOT) in 6 patients, above the pulmonary valve in 1 patient, left coronary cusp in 1 patient, and unknown in 1 patient. The PAP was detected in six (67%) patients with bipolar voltage of 0.56 ± 0.27 mV. Pacing from bipolar electrodes of the circumferential catheter located above the pulmonary valve captured the PA myocardium only in 1 patient who had the PA-VT (100% in PA-VT vs 0% in non-PA-VT, P = 0.0046), and slight changes of the QRS morphology was observed in accordance with the conduction delay from the stimulus to activation of the RVOT myocardium. The selective PAP capture with conduction delays evoked by bipolar stimulations through a 20-polar circumferential catheter may be a characteristic property of patients with the PA-VT. Conduction delays within the PA and PA-RVOT junction appears to contribute polymorphic QRS changes during the PA-VT.

Keywords

Ventricular tachycardia Polymorphic Pulmonary artery potential Pulmonary valve Intracardiac echocardiography 

Notes

Acknowledgements

We thank Drs. Masayuki Sakurai and Akihiko Yotsukura, Hokko Memorial Hospital, and Dr. Minoru Sato, National Hospital Organization Hokkaido Medical Center, for constant encouragement of this study.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Masayuki Takahashi
    • 1
  • Hisashi Yokoshiki
    • 2
    Email author
  • Hirofumi Mitsuyama
    • 3
  • Taro Tenma
    • 1
  • Masaya Watanabe
    • 1
  • Rui Kamada
    • 1
  • Ryo Sasaki
    • 4
  • Yuki Chiba
    • 4
  • Motoki Maeno
    • 4
  • Toshihisa Anzai
    • 1
  1. 1.Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
  3. 3.Department of Cardiovascular MedicineHokkaido Ohno Memorial HospitalSapporoJapan
  4. 4.Division of Medical Engineering CenterHokkaido University HospitalSapporoJapan

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