Determinants of successful ablation of idiopathic ventricular tachycardias with left bundle branch block morphology from the right ventricular outflow tract

S. H. Lee, Ching Tai Tai, Chern En Chiang, Jin Long Huang, Chuen Wang Chiou, Yu An Ding, Mau Song Chang, Shih Ann Chen

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19 Citations (Scopus)

Abstract

The aim of the study was to define the factors that may predict the outcomes of radiofrequency ablation from the right ventricular outflow tract (RVOT) in patients with idiopathic VT with a QRS morphology of LBBB. Endocardial mapping and RF ablation from the RVOT were performed in 35 patients (14 men, mean age 41 ± 14 years), and VT was successfully ablated in 30 patients. There was no significant difference with regard to clinical characteristics and electrophysiological findings between patients with successful and failed ablation. The VTs with successful ablation showed an rS (n = 16) or QS (n = 14) pattern in lead V1, and all five VTs with failed ablation showed an rS pattern in lead V1. Although the absence of an R wave in lead V1 did not differ between patients with successful and failed ablation (P = 0.13), the absence of an R wave in lead V1 predicted VT successfully ablated from the RVOT (positive predictive value 100%; negative predictive value 24%). The VTs with successful ablation had a median precordial transitional zone at lead V4 (range V3-V6), whereas all five VTs with failed ablation had precordial transition zones at lead V3 (P = 0.004). Furthermore, a presence of an R wave in lead V1 associated with a precordial transition zone at lead V3 predicted VT not successfully ablated from the RVOT (positive predictive value 100%; negative predictive value 100%). In conclusion, some VTs with LBBB and inferior or normal axis cannot be ablated from the RVOT. The presence of an R wave in lead V1 associated with a precordial transition zone at lead V3 suggest that some VTs may not arise from the RVOT.

Original languageEnglish
Pages (from-to)1346-1351
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume25
Issue number9
DOIs
Publication statusPublished - Sep 1 2002
Externally publishedYes

Keywords

  • Ablation
  • Electrocardiography
  • Idiopathic
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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