Key result
Pulmonary artery-derived ventricular arrhythmias feature a ~13 ms wider baseline QRS duration than RVOT arrhythmias.
Why the study?
Although ventricular arrhythmias have been ablated from pulmonary sinus cusps establishing the pulmonary artery as an arrhythmic focus, their clinical presentation, electrocardiographic, and ablation characteristics required determination.
What are the clinical, electrocardiographic, and ablation characteristics of ventricular arrhythmias arising from the pulmonary artery compared to the right ventricular outflow tract?
Observational (n=30)
No
What are the clinical, electrocardiographic, and ablation characteristics of ventricular arrhythmias arising from the pulmonary artery compared to the right ventricular outflow tract?
Absolute Event Rate: 155% vs 142.4%
p-value: p=<.01
Ventricular arrhythmias originating from the pulmonary artery have a wider baseline QRS duration than RVOT-VAs, and mapping utilizing the reversed U method can aid in their successful localization and ablation.
May refine pre-procedural localization of outflow tract VAs; leaves open prospective confirmation of mapping strategies.
Introduction Ventricular arrhythmias (VAs) have been successfully ablated from the pulmonary sinus cusps establishing pulmonary artery (PA) as a distinct site of arrhythmic foci. The aim of the present study was to determine the clinical presentation, electrocardiographic, and ablation characteristics of PA‐VAs. Methods Thirty consecutive patients with right ventricular outflow tract (RVOT)‐type VAs were included in this retrospective study. Three‐dimensional electroanatomic mapping was performed in all patients. Mapping was performed initially in RVOT, and later within the PA. Mapping was performed in the PA if there was no early activation, unsatisfactory pace‐map, or ablation in RVOT were unsuccessful. All PA‐VAs were mapped and ablated by looping the catheter in a reverse U fashion. Results Among 30 patients, 8 (26.6%) patients VAs were successfully ablated within PA. Electrocardiography (ECG) revealed that the QRS duration was significantly wider in the PA‐VAs group compared to the RVOT‐VAs group (155 ± 14.14 vs 142.40 ± 8.12 ms, P < .01). Mapping by reversed U method of PA‐VAs revealed earlier activation (55 ± 9.66 vs 12.00 ± 8.61 ms, P < .01) in PA compared to RVOT. An isolated discrete prepotential was present at the successful site in 50% (n = 4). Conclusion Pulmonary artery‐VAs are an important subset of VA originating from the outflow tract. They have a wider baseline QRS duration compared to RVOT‐VAs. Presence of a prepotential aids in the identification of a successful ablation site. Mapping utilizing the reversed U method can help in localization and successful ablation of PA‐VAs.
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Rangaswamy et al. (2020) conducted an observational in Ventricular arrhythmias originating from the outflow tract (n=30). Radiofrequency catheter ablation in the pulmonary artery vs. Right ventricular outflow tract ablation was evaluated on QRS duration (p=<.01). Pulmonary artery-derived ventricular arrhythmias have a significantly wider baseline QRS duration (155 ms vs 142.4 ms) compared to right ventricular outflow tract arrhythmias.
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