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Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties

  • Chung-Hsing Lin
  • Li-Wei Lo
  • Yenn-Jiang Lin
  • Shih-Lin Chang
  • Yu-Feng Hu
  • Ta-Chuan Tuan
  • Hung-Kai Huang
  • Cheng-Hung Chiang
  • Suresh Allamsetty
  • Jo-Nan Liao
  • Fa-Po Chung
  • Yao-Ting Chang
  • Chin-Yu Lin
  • Abigail Louise D. Te
  • Shinya Yamada
  • Rohit Walia
  • Yuan Hung
  • Shih-Ann Chen
Article

Abstract

Purpose

There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD).

Methods

We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment.

Results

There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers.

Conclusions

In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.

Keywords

Crux Ventricular arrhythmias Interventricular septum Structural heart diseases 

Notes

Funding

Taipei Veterans General Hospital (V102B-002, V102E7-003, V103C-042, V103C-126, V103E7-002, VGHUST103-G1-3-1, V104C-131, V104E7-003, VA105C-60), Ministry of Science and Technology (NSC 101-2911-I-008-001, NSC 102-2325-B-010-005, MOST 103-2314-B-075-062-MY3, MOST 104-2314-B-075-065-MY2), and Research Foundation of Cardiovascular Medicine (RFCM 100-02-011, 101-01-001, 104-01-009-01).

Compliance with ethical standards

All patients gave written informed consent prior to the ablation procedures in accordance with institutional guidelines of the Taipei Veteran General Hospital. The study has been approved by the Institutional Review Board committee of Taipei Veterans General Hospital (IRB No: 2017-06-001 BC).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional Review Board committee of Taipei Veterans General Hospital (IRB No: 2017-06-001 BC).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chung-Hsing Lin
    • 1
    • 2
  • Li-Wei Lo
    • 1
    • 3
  • Yenn-Jiang Lin
    • 1
    • 3
  • Shih-Lin Chang
    • 1
    • 3
  • Yu-Feng Hu
    • 1
    • 3
  • Ta-Chuan Tuan
    • 1
    • 3
  • Hung-Kai Huang
    • 1
    • 4
  • Cheng-Hung Chiang
    • 1
    • 5
  • Suresh Allamsetty
    • 1
    • 6
  • Jo-Nan Liao
    • 1
    • 3
  • Fa-Po Chung
    • 1
    • 3
  • Yao-Ting Chang
    • 1
    • 3
  • Chin-Yu Lin
    • 1
    • 3
  • Abigail Louise D. Te
    • 1
  • Shinya Yamada
    • 1
    • 7
  • Rohit Walia
    • 1
    • 8
  • Yuan Hung
    • 1
    • 9
  • Shih-Ann Chen
    • 1
    • 3
  1. 1.Division of Cardiology, Department of Medicine, Heart Rhythm CenterTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Division of Cardiology, Department of MedicineTaipei Medical University, Shuang Ho HospitalTaipeiTaiwan
  3. 3.Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang-Ming UniversityTaipeiTaiwan
  4. 4.Division of Cardiology, Department of MedicineChanghua Christian HospitalChanghuaTaiwan
  5. 5.Division of Cardiology, Department of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
  6. 6.Apollo HospitalVisakhapatnamIndia
  7. 7.Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
  8. 8.Bhagat Phool Singh Government Medical CollegeSonipatIndia
  9. 9.Division of Cardiology, Department of Internal Medicine, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan

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