Electrophysiological properties and involvement of anatomical factors for the prediction of intramural origin in patients with ventricular tachyarrhythmia arising from the left ventricular outflow tract

Abstract

Purpose

To elucidate the electrophysiological predictors of the intramural origins of left ventricular outflow tract-ventricular tachyarrhythmias (LVOT-VAs), and to clarify the involvement of anatomical factors.

Methods

Twenty-nine successfully ablated LVOT-VAs patients with origins in the aortomitral continuity (AMC) (n = 8), aortic sinus of valsalva (ASV) (n = 9), great cardiac vein (GCV) (n = 5), and intramural myocardium (n = 7) were enrolled. Intramural origins were defined as when effective ablation from AMC and epicardium (ASV and/or GCV) was needed. The local activation time difference (LATD) was calculated as follows: (earliest AMC activation) (earliest epicardial activation), and was presented as an absolute value. Electrophysiological parameters and anatomical factors predisposing the intramural origins were investigated.

Results

LATD of intramural origins was significantly shorter than that of AMC and GCV (4.5 ± 2.6 vs. 12.1 ± 7.4 vs. 17.4 ± 4.7, P < 0.05), respectively. In multivariate logistic regression analysis, LATD was associated with intramural origins (odds ratio: 0.711, confidence interval: 0.514−0.985, P = 0.040). ROC analysis revealed LATD of 7 ms as cut-off value. In computed tomography analysis, some patients who had thick fat tissue below the GCV, and an unusual GCV running pattern might be misdiagnosed as intramural origins.

Conclusion

LATD ≤ 7 ms was associated with intramural origins, but with some anatomical limitations.

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Data availability

The deidentified participant data will be shared on a request basis. Please directly contact the corresponding author to request data sharing.

Code availability

Not applicable.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Naoko Hijioka, Minoru Nodera, Shinya Yamada, Takashi Kaneshiro, and Yasuchika Takeishi. The first draft of the manuscript was written by Masashi Kamioka, and all authors commented on previous versions of the manuscript.

Corresponding author

Correspondence to Masashi Kamioka.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the ethical committee of Fukushima Medical University (No. 1808).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

Competing interests

Takashi Kaneshiro belongs to department of arrhythmia and cardiac pacing supported by Abbott and Biotronik Co, Ltd. These companies are not associated with contents of this study.

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Kamioka, M., Hijioka, N., Nodera, M. et al. Electrophysiological properties and involvement of anatomical factors for the prediction of intramural origin in patients with ventricular tachyarrhythmia arising from the left ventricular outflow tract. J Interv Card Electrophysiol (2021). https://doi.org/10.1007/s10840-021-00959-3

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Keywords

  • Aortomitral continuity
  • Intramural origins
  • Great cardiac vein
  • Left ventricular outflow tract
  • Ventricular tachyarrhythmias