Outflow tract SOO
Robert Anderson et al. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias. Circulation: Arrhythmia and Electrophysiology. 2019;12:e007392
ECG - Broad principles
Robert Anderson et al. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias. Circulation: Arrhythmia and Electrophysiology. 2019;12:e007392
Early transition - Left
Transition at V3
Transition ratio
V3 transition - LVOT vs RVOT
Early transition - LV or aorta ?
Varying coupling
Bradfield JS, Homsi M, Shivkumar K, Miller JM. Coupling interval variability differentiates ventricular ectopic complexes arising in the aortic sinus of valsalva and great cardiac vein from other sources: mechanistic and arrhythmic risk implications. J Am Coll Cardiol. 2014;63(20):2151-2158. https://doi.org/10.1016/j.jacc.2014.02.551
Start with a deeply placed CS catheter
Deflectable sheath in CS
Deflectable sheath in CS
Deflectable sheath in CS
Irrigation for summit VA
Potential reversal in aortic sinus
Selvaraj RJ et al. Ablation of ventricular tachycardia arising from the left coronary cusp. Heart 2011;97:1720.
Unipolar less useful
Low Power
- 15-30 W may suffice
- Immediate cessation of PVCs indicator of success
- No long term recurrence
Kabilan … Raja Selvaraj. Low power ablation for left coronary cusp ventricular tachycardia—Efficacy and long-term outcome. Indian Heart Journal 2018;17:S384-S388
Distance from coronaries
Distance from coronaries
Pulmonary cusp VT
Liao Z et al. Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp: Prevalence, electrocardiographic/electrophysiological characteristics, and catheter ablation. J Am Coll Cardiol 2015; 66: 2633–2644.
Summit PVCs
Mapping
High power ablation
Delayed effect
Ding L et al. (2017). Delayed efficacy of radiofrequency catheter ablation on ventricular arrhythmias originating from the left ventricular anterobasal wall. Heart Rhythm, 14(3), 341–349
Summary
- ECG helps broad localization
- Left or right ? - PVC transition, R in V2, sinus transition
- Deep CS catheter, sheath in CS
- Signal in aortic / pulmonary cusps
- Delayed ablation effect