Radiofrequency ablation of idiopathic ventricular arrhythmias originating from free wall of tricuspid annulus

Objective To evaluate the safety and efficacy of radiofrequency catheter ablation of idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVC) originating from free wall of tricuspid annulus. The efficacy and security of catheter emplacement for mapping and ablation were also investigated. Methods From November 2015 to November 2017, 20 patients with idiopathic PVC/VT originating from free wall of tricuspid annulus were observed retrospectively in cardiology department of the first affiliated hospital of Zhengzhou University. The PVC/VT targets were localized by anatomic reconstruction and activation mapping under 3D cardiac electroanatomic system with large curve or small curve maneuver. To analyze the PVC/VT foci distribution feature, surface electrocardiogram characteristics, summarize the safety and efficacy of large curve or small curve maneuver for catheter emplacement. Results The PVC /VT targets originating from the free wall of tricuspid annulus were distributed posterior wall (40%) , lateral wall (35%) , and anterior wall (25%) . The electrocardiogram (ECG) of PVC/VT had the following features: left bundle branch block pattern wave in V1 (100%) ; positive wave in lead Ⅰ and aVL (100% and 80% respectively) ; chest lead transition after V3 (100%) . The large curve (35%) and small curve (65%) maneuver were used. All PVC/VT were terminated completely. Conclusion PVC /VT originating from the free wall of tricuspid annulus can be effectively eliminate by special catheter maneuver. The ECG of this kind of ventricular arrhythmia has special features.