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
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).
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.
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.
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.
KeywordsCrux Ventricular arrhythmias Interventricular septum Structural heart diseases
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.
Institutional Review Board committee of Taipei Veterans General Hospital (IRB No: 2017-06-001 BC).
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