Catheter ablation of idiopathic ventricular arrhythmias originating from left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein

Objectives

This study aimed to investigate electrocardiographic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic premature ventricular complexes (PVCs) and idiopathic ventricular tachycardias (IVTs), originating from the different portions of the left coronary veins.

Background

Inadequate distinction was made in the past for the PVC/IVTs located in the different portions of the left coronary veins, especially the distal great cardiac vein (DGCV) and the proximal portion of the anterior interventricular vein (PAIV) and the extended tributary of DGCV located distal to the origin of AIV (EDGCV).

Methods

Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 12 patients with symptomatic PVCs/IVTs originating from the vicinity of the left coronary veins.

Results

Among 490 patients with PVCs/IVTs, the incidence of ventricular arrhythmias originating from the left ventricular epicardium adjacent to the transitional area from the GCV to the AIV was 2.45%. Four had PVCs/IVTs from DGCV, 5 from PAIV, and 3 from EDGCV. There were different characteristics of ECG of PVCs/VT originating from the DGCV and PAIV and EDGCV. Successful RFCA in all 12 patients could be achieved (100% acute procedural success). No complications were observed. During a median follow up of 17 months (range 6–45 months), 2 had recurrent ventricular arrhythmia (recurrence rate: 16.67%).

Conclusions

ECG characteristics of PVCs/VTs originating from the different portions of the left coronary veins (DGCV and PAIV and EDGCV) are different, and can help regionalize the origin of these arrhythmias. RFCA within the coronary venous system was relatively effective and safe for the PVCs/IVTs and should be seen as an alternative approach, when the left-sided PVCs/IVTs could not be eliminated by RFCA from the endocardium or aortic sinus of Valsalva.