Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties

Chung-Hsing Lin, Li Wei Lo, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Ta Chuan Tuan, Hung Kai Huang, Cheng Hung Chiang, Suresh Allamsetty, Jo Nan Liao, Fa Po Chung, Yao Ting Chang, Chin Yu Lin, Abigail Louise D. Te, Shinya Yamada, Rohit Walia, Yuan Hung, Shih Ann Chen

研究成果: 雜誌貢獻文章

1 引文 (Scopus)

摘要

Purpose: There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). Methods: We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. Results: There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers. Conclusions: In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.

原文英語
頁(從 - 到)225-236
頁數12
期刊Journal of Interventional Cardiac Electrophysiology
52
發行號2
DOIs
出版狀態已發佈 - 七月 1 2018

指紋

Cardiac Arrhythmias
Heart Diseases
Endocardium
Heart Ventricles
Electrocardiography
Epicardial Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

引用此文

Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases : characteristics, mapping, and electrophysiological properties. / Lin, Chung-Hsing; Lo, Li Wei; Lin, Yenn Jiang; Chang, Shih Lin; Hu, Yu Feng; Tuan, Ta Chuan; Huang, Hung Kai; Chiang, Cheng Hung; Allamsetty, Suresh; Liao, Jo Nan; Chung, Fa Po; Chang, Yao Ting; Lin, Chin Yu; Te, Abigail Louise D.; Yamada, Shinya; Walia, Rohit; Hung, Yuan; Chen, Shih Ann.

於: Journal of Interventional Cardiac Electrophysiology, 卷 52, 編號 2, 01.07.2018, p. 225-236.

研究成果: 雜誌貢獻文章

Lin, Chung-Hsing ; Lo, Li Wei ; Lin, Yenn Jiang ; Chang, Shih Lin ; Hu, Yu Feng ; Tuan, Ta Chuan ; Huang, Hung Kai ; Chiang, Cheng Hung ; Allamsetty, Suresh ; Liao, Jo Nan ; Chung, Fa Po ; Chang, Yao Ting ; Lin, Chin Yu ; Te, Abigail Louise D. ; Yamada, Shinya ; Walia, Rohit ; Hung, Yuan ; Chen, Shih Ann. / Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases : characteristics, mapping, and electrophysiological properties. 於: Journal of Interventional Cardiac Electrophysiology. 2018 ; 卷 52, 編號 2. 頁 225-236.
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title = "Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases: characteristics, mapping, and electrophysiological properties",
abstract = "Purpose: There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). Methods: We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. Results: There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers. Conclusions: In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.",
keywords = "Crux, Interventricular septum, Structural heart diseases, Ventricular arrhythmias",
author = "Chung-Hsing Lin and Lo, {Li Wei} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Hu, {Yu Feng} and Tuan, {Ta Chuan} and Huang, {Hung Kai} and Chiang, {Cheng Hung} and Suresh Allamsetty and Liao, {Jo Nan} and Chung, {Fa Po} and Chang, {Yao Ting} and Lin, {Chin Yu} and Te, {Abigail Louise D.} and Shinya Yamada and Rohit Walia and Yuan Hung and Chen, {Shih Ann}",
year = "2018",
month = "7",
day = "1",
doi = "10.1007/s10840-018-0350-2",
language = "English",
volume = "52",
pages = "225--236",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",
number = "2",

}

TY - JOUR

T1 - Ventricular arrhythmias originating from the cardiac crux and the basal inferior segment of the interventricular septum in the patients with structural heart diseases

T2 - characteristics, mapping, and electrophysiological properties

AU - Lin, Chung-Hsing

AU - Lo, Li Wei

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Hu, Yu Feng

AU - Tuan, Ta Chuan

AU - Huang, Hung Kai

AU - Chiang, Cheng Hung

AU - Allamsetty, Suresh

AU - Liao, Jo Nan

AU - Chung, Fa Po

AU - Chang, Yao Ting

AU - Lin, Chin Yu

AU - Te, Abigail Louise D.

AU - Yamada, Shinya

AU - Walia, Rohit

AU - Hung, Yuan

AU - Chen, Shih Ann

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Purpose: There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). Methods: We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. Results: There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers. Conclusions: In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.

AB - Purpose: There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). Methods: We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. Results: There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P < 0.0001), lower unipolar voltages (4.05 ± 1.92 vs. 5.75 ± 2.90 mv, P < 0.0001), and longer local electrocardiogram (EGM) lateness (157.6 ± 47.9 vs.140.3 ± 52.5 ms, P = 0.0001) in the dominant chambers. Conclusions: In VAs from the crux and the corresponding endocardial site, the complete ECG V2R/V3R ratio and V3 transition ratio percentage could differentiate the VAs from the RV or LV endocardium. The lower unipolar, bipolar voltage mapping, and longer EGM lateness are helpful to identify the abnormal substrate in the endocardium in these patients.

KW - Crux

KW - Interventricular septum

KW - Structural heart diseases

KW - Ventricular arrhythmias

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U2 - 10.1007/s10840-018-0350-2

DO - 10.1007/s10840-018-0350-2

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JO - Journal of Interventional Cardiac Electrophysiology

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SN - 1383-875X

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