Simultaneous Mapping in the Left Sinus of Valsalva and Coronary Venous System Predicts Successful Catheter Ablation from the Left Sinus of Valsalva

Idiopathic ventricular tachycardia originating from the left epicardium (Epi-VT) can be ablated from the left sinus of Valsalva (LSV) in selected patients. We hypothesized that the analysis of electrograms at the LSV and transitional zone from the great cardiac vein to the anterior interventricular vein (GCV-AIV) could predict the efficacy of radiofrequency catheter ablation (RFCA) from the LSV. Simultaneous mapping in the LSV and coronary venous system was performed in 25 patients (12 VTs and 13 premature ventricular contractions). The earliest ventricular activation (VA) during the arrhythmias was found at the LSV or GCV-AIV in all patients. RF applications from the LSV were successful in 17 patients success group (S-Gr) and failed in 8 failure group (F-Gr). The earliness of the VA recorded in the LSV (VALSV) and in GCV-AIV (VAGCV-AIV) was compared between the two groups. (1) The VALSV preceded the QRS onset by 28 +/- 11 ms in S-Gr and 14 +/- 10 ms in F-Gr (P < 0.01). (2) In S-Gr, the VAGCV-AIV was earlier than the VALSV in 5 five patients (35%). However, in F-Gr, the VAGCV-AIV was earlier than the VALSV in all patients. (3) In patients in whom the earliest VA was found at the LSV or GCV-AIV, a VA GCV-AIV preceding the VALSV by less than 10 ms identified successful RFCA from the LSV with a sensitivity of 88 %, specificity of 100%, and high predictive value. With a detailed analysis of the electrograms recorded from the GCV-AIV and LSV, it was possible to identify the successful catheter ablation of Epi-VT from the LSV.