An Organized Approach to the Localization, Mapping, and Ablation of Outflow Tract Ventricular Arrhythmias

• Published in: Journal of cardiovascular electrophysiology Vol. 24; no. 10; pp. 1189 - 1197
• Main Authors: HUTCHINSON, MATHEW D., GARCIA, FERMIN C.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-10-2013; Wiley Subscription Services, Inc
• Subjects: Cardiac arrhythmia; catheter ablation; Catheter Ablation - methods; Catheters; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; intracardiac echocardiography; Predictive Value of Tests; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Treatment Outcome; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - surgery; ventricular premature complexes; Ventricular Premature Complexes - diagnosis; Ventricular Premature Complexes - physiopathology; Ventricular Premature Complexes - surgery; ventricular tachycardia; catheter ablation; ventricular tachycardia; ventricular premature complexes; intracardiac echocardiography; electrocardiography
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.12237

Localization, Mapping, and Ablation of Outflow Tract Ventricular Arrhythmias
The outflow tract (OT) regions of the right and left ventricles, common sites of origin for idiopathic ventricular arrhythmias (VA), have complex three‐dimensional anatomical relationships. The understanding of in situ or “attitudinal” relationships not only informs the electrocardiographic interpretation of VA site of origin, but also facilitates their catheter‐based mapping and ablation strategies. By viewing each patient as his or her own “control,” the expected changes in ECG morphology (i.e., frontal plane QRS axis and precordial transition) between adjacent intracardiac structures (e.g., RVOT and aortic root) can be reliably predicted. Successful mapping of OT VAs involve a combination of activation and pacemapping guided by fluoroscopy, electroanatomical mapping, and intracardiac echocardiography. The purpose of this manuscript is to provide a simple, reliable strategy for catheter based mapping and ablation of OT VAs. We also discuss 2 specific challenges in OT VA mapping: (1) differentiating posterior RVOT from right coronary cusp VA origin; and (2) mapping VAs originating from the LV summit.