Author + information
- Received February 15, 2019
- Revision received April 4, 2019
- Accepted April 22, 2019
- Published online May 7, 2019.
- Jackson J. Liang, DO,
- Yasuhiro Shirai, MD,
- David F. Briceño, MD,
- Daniele Muser, MD,
- Andres Enriquez, MD,
- Aung Lin, MD,
- Matthew C. Hyman, MD, PhD,
- Ramanan Kumareswaran, MD,
- Jeffrey S. Arkles, MD,
- Pasquale Santangeli, MD, PhD,
- Robert D. Schaller, DO,
- Gregory E. Supple, MD,
- David S. Frankel, MD,
- Rajat Deo, MD,
- Andrew E. Epstein, MD,
- Fermin C. Garcia, MD,
- Michael P. Riley, MD, PhD,
- Saman Nazarian, MD, PhD,
- David Lin, MD,
- David J. Callans, MD,
- Francis E. Marchlinski, MD and
- Sanjay Dixit, MD∗ ()
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Sanjay Dixit, Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Background The inferior basal septum is an uncommon source of idiopathic ventricular arrhythmias (VA), which can arise from its endocardial or epicardial (crux) aspect. Because the latter are often targeted from the coronary venous system or epicardium, distinguishing between the 2 is important for successful ablation.
Objectives This study sought to characterize VA ablated from the basal inferoseptal left ventricular endocardium (BIS-LVe) and identify electrocardiographic characteristics to differentiate from inferobasal crux (IBC) VA.
Methods Consecutive patients undergoing ablation of idiopathic VA from the BIS-LVe or IBC from 2009 to 2018 were identified and clinical characteristics and electrocardiographs of VA were compared.
Results Of 931 patients undergoing idiopathic VA ablation, Virginia was eliminated from the BIS-LVe in 19 patients (2%) (17 male, age 63.7 ± 9.2 years, LV ejection fraction: 45.0 ± 9.3%). QRS complexes typically manifested right bundle branch block morphology with “reverse V2 pattern break” and left superior axis (more negative in lead III than II). VA elimination was achieved after median of 2 lesions (interquartile range 1, 6; range 1 to 20) (radiofrequency ablation time: 123 s [interquartile range 75, 311]). Compared with 7 patients with IBC VA (3 male, age 51.9 ± 20.1 years, LV ejection fraction: 51.4 ± 17.7%), BIS-LVe VA less frequently had initial negative forces (QS pattern) in leads II, III, and/or aVF (p < 0.001), R-S ratio <1 in lead V1 (p = 0.005), and notching in lead II (p = 0.006) were narrower (QRS duration: 178.2 ± 22.4 vs. 221.1 ± 41.9 ms, p = 0.04) and more frequently had maximum deflection index of <0.55 (p < 0.001).
Conclusions The BIS-LVe region is an uncommon source of idiopathic VA. Distinguishing these from IBC VA is important for procedural planning and ablation success.
- catheter ablation
- left ventricular ostium
- premature ventricular complexes
- ventricular arrhythmia
This work was supported in part by the Richard T. Angela Clark Electrophysiology Innovation Fund and the Mark S. Marchlinski Electrophysiology Research Fund. Dr. Arkles has received consulting fees from Biosense Webster. Dr. Nazarian has received research funding from Siemens, ImriCor, and Biosense Webster. All other 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 February 15, 2019.
- Revision received April 4, 2019.
- Accepted April 22, 2019.
- 2019 American College of Cardiology Foundation
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