Evaluation of the pulmonary artery potential using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography
- 88 Downloads
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.
KeywordsVentricular tachycardia Polymorphic Pulmonary artery potential Pulmonary valve Intracardiac echocardiography
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.
- 1.Liao Z, Zhan X, Wu S, Xue Y, Fang X, Liao H, Deng H, Liang Y, Wei W, Liu Y, Ouyang F (2015) Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp: prevalence, electrocardiographic/electrophysiological characteristics, and catheter ablation. J Am Coll Cardiol 66:2633–2644CrossRefGoogle Scholar
- 2.Liu CF, Cheung JW, Thomas G, Ip JE, Markowitz SM, Lerman BB (2014) Ubiquitous myocardial extensions into the pulmonary artery demonstrated by integrated intracardiac echocardiography and electroanatomic mapping: changing the paradigm of idiopathic right ventricular outflow tract arrhythmias. Circ Arrhythm Electrophysiol 7:691–700CrossRefGoogle Scholar
- 5.Yamashina Y, Yagi T, Namekawa A, Ishida A, Sato H, Nakagawa T, Sakuramoto M, Sato E, Yambe T (2010) Clinical and electrophysiological difference between idiopathic right ventricular outflow tract arrhythmias and pulmonary artery arrhythmias. J Cardiovasc Electrophysiol 21:163–169CrossRefGoogle Scholar
- 15.Yagishita A, Yamauchi Y, Sato H, Yamashita S, Hirao T, Usui E, Kawahatsu K, Miyazaki R, Yamaguchi T, Hara N, Umemoto T, Miyamoto T, Obayashi T, Hirao K, Aonuma K (2014) Pulmonary artery isolation for idiopathic polymorphic outflow tract ventricular tachycardia. J Jpn Soc Clin Card Electrophysiol 37:111–118Google Scholar
- 17.Hasdemir C, Aktas S, Govsa F, Aktas EO, Kocak A, Bozkaya YT, Demirbas MI, Ulucan C, Ozdogan O, Kayikcioglu M, Can LH, Payzin S (2007) Demonstration of ventricular myocardial extensions into the pulmonary artery and aorta beyond the ventriculo-arterial junction. Pacing Clin Electrophysiol 30:534–539CrossRefGoogle Scholar
- 18.Gami AS, Noheria A, Lachman N, Edwards WD, Friedman PA, Talreja D, Hammill SC, Munger TM, Packer DL, Asirvatham SJ (2011) Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts. J Interv Card Electrophysiol 30:5–15CrossRefGoogle Scholar
- 23.Postema PG, van Dessel PF, de Bakker JM, Dekker LR, Linnenbank AC, Hoogendijk MG, Coronel R, Tijssen JG, Wilde AA, Tan HL (2008) Slow and discontinuous conduction conspire in Brugada syndrome: a right ventricular mapping and stimulation study. Circ Arrhythm Electrophysiol 1:379–386CrossRefGoogle Scholar
- 29.Nakagawa H, Yamanashi WS, Pitha JV, Arruda M, Wang X, Ohtomo K, Beckman KJ, McClelland JH, Lazzara R, Jackman WM (1995) Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation 91:2264–2273CrossRefGoogle Scholar