Author + information
- Received September 7, 2017
- Revision received November 2, 2017
- Accepted November 2, 2017
- Published online March 19, 2018.
- Masaharu Masuda, MD, PhD∗ (, )
- Mitsutoshi Asai, MD, PhD,
- Osamu Iida, MD,
- Shin Okamoto, MD,
- Takayuki Ishihara, MD,
- Kiyonori Nanto, MD,
- Takashi Kanda, MD,
- Takuya Tsujimura, MD,
- Yasuhiro Matsuda, MD,
- Shota Okuno, MD,
- Takuya Ohashi, MD,
- Aki Tsuji, MD and
- Toshiaki Mano, MD, PhD
- ↵∗Address for correspondence:
Dr. Masaharu Masuda, Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki-shi, Hyogo 660-8511, Japan.
Objectives The aim of this study was to assess the use of wave front propagation speed on a right ventricular map for determining the earliest activation site as the origin of outflow tract ventricular arrhythmias (VAs).
Background VAs with centrifugal right ventricular outflow tract (RVOT) activation can be from an RVOT focus or a focus outside the RVOT.
Methods This prospective observational study included 23 patients with idiopathic outflow tract VAs. Mapping of the RVOT was performed using a new ultra-high-resolution electroanatomic mapping system. The wave front propagation speed was estimated from the area surrounded by a propagated wave front at 5, 10, 15, and 20 ms after the earliest activation.
Results VAs disappeared following ablations in the RVOT in 15 patients (RVOT origin). The remaining 8 patients had VAs of non-RVOT origin determined by ablation success at another site or ablation failure. The areas surrounded by a propagated wave front were significantly smaller in VAs of RVOT origin than non-RVOT VAs at 5 ms (1.0 [0.7 to 1.1] cm2 vs. 2.2 [1.6 to 4.4] cm2), 10 ms (1.9 [1.4 to 2.2] cm2 vs. 4.5 [3.2 to 5.8] cm2), 15 ms (3.2 [2.3 to 4.4] cm2 vs. 7.1 [6.3 to 9.8] cm2), and 20 ms (5.0 [3.0 to 6.6] cm2 vs. 9.8 [9.3 to 14.8] cm2). A propagated area of <5.0 cm2 at 15 ms predicted RVOT VAs with 87% sensitivity, 100% specificity, and 91% predictive accuracy.
Conclusions VAs with slow wave front propagation speed on the right ventricular map indicate an RVOT origin.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 7, 2017.
- Revision received November 2, 2017.
- Accepted November 2, 2017.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.