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J Cardiovasc Electrophysiol. 2017 Jan;28(1):78-84. doi: 10.1111/jce.13098. Epub 2016 Oct 6.

Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways.

Author information

1
Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
2
Department of Cardiology, School of Medicine Department of Cardiology, Balçova, Izmir, Turkey.
3
Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
4
Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
5
Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
6
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Multiple mechanisms have been proposed for idiopathic premature ventricular contractions (PVCs) originating from the outflow tracts (OTs). Recent observations such as the coexistence of these arrhythmias with atrioventricular nodal reentrant tachycardias and the association between discrete prepotentials and successful ablation sites of ventricular arrhythmias (VAs) from the OTs suggest a common link.

OBJECTIVE:

In this case series we draw attention to a unique association between accessory pathways (APs) and idiopathic PVCs from the OTs, disappearing after AP ablation.

METHODS:

We identified 6 cases in collaboration with several international electrophysiology centers, which presented with pre-excitation in association with OT, and in 1 case inflow tract (IT), PVCs on 12-lead surface ECG.

RESULTS:

Six cases displayed pre-excitation and PVCs, in 5 cases originating from the right ventricular outflow tract (RVOT) and in 1 case from the right ventricular inflow tract (RVIT). In all patients, PVCs were monomorphic and had fixed coupling intervals, in 3 cases presenting in bigeminy. Catheter ablation of the AP led to the simultaneous disappearance of PVCs in 5 of 6 cases. The sites of ablation were remote from the OTs in all these cases. In most cases, the occurrence of OT PVCs was closely associated with the presence of pre-excitation.

CONCLUSION:

The coexistence of pre-excitation and PVCs from the OTs and the fact that in 5 of 6 cases PVCs disappeared after AP ablation suggests a common mechanism for arrhythmia genesis.

KEYWORDS:

accessory pathway; case series; catheter ablation; idiopathic ventricular arrhythmias; international

PMID:
27625076
DOI:
10.1111/jce.13098
[Indexed for MEDLINE]

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