Clinical and electrocardiographic characteristics of idiopathic ventricular arrhythmias with right bundle branch block and superior axis: Comparison of apical crux area and posterior septal left ventricle

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Mitsuharu KawamuraNitish Badhwar

Abstract

Right bundle branch block (RBBB) with superior axis electrocardiographic (ECG) morphology is common in patients with idiopathic ventricular arrhythmia (VA) originating from the left posterior fascicle (LPF), from the left ventricular (LV) posterior papillary muscles (PPM), and rarely from the cardiac apical crux. The purpose of this study was to describe the ECG and clinical characteristics of idiopathic VA presenting with RBBB and superior axis. We studied 40 patients who underwent successful catheter ablation of idiopathic VAs originating from the LPF (n = 18), LV PPM (n = 15), and apical crux (n = 7). We investigated clinical and ECG characteristics, including maximum deflection index and QRS morphology in leads aVR and V6. Syncope was more frequently seen in apical crux VA compared with other VAs (57% vs 6%, P < .001). Patients with apical crux VA more frequently had an maximum deflection index ≥0.55 compared with LPF VA and PPM VA (P = .02). A monophasic R wave in aVR and QS or r/S ratio <0.15 in V6 (P < .001) could distinguish apical crux VA from other VAs with high accuracy. All patients with VA underwent attempted ablation in the endocardium (success rate: LPF 89%, PPM 80%, crux 14%). Only 1 of 7 patients with apical cr...Continue Reading

References

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Sep 17, 2014·Circulation. Arrhythmia and Electrophysiology·Mitsuharu KawamuraNitish Badhwar

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Citations

Nov 26, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Larissa Fabritz
Aug 16, 2016·Cardiac Electrophysiology Clinics·Alex Y Tan, Kenneth Ellenbogen
Feb 28, 2016·Cardiac Electrophysiology Clinics·Leila Larroussi, Nitish Badhwar
Jun 28, 2020·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Yulong Xiong, Hongling Zhu
Jun 14, 2015·Expert Review of Cardiovascular Therapy·Duong LeRandall J Lee
Jul 21, 2017·Journal of Cardiovascular Electrophysiology·James E Ip
Apr 28, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Shixing LiYutang Wang
Jun 4, 2021·Circulation Journal : Official Journal of the Japanese Circulation Society·Akihiko NogamiUNKNOWN JCS/JHRS Joint Working Group
Aug 14, 2021·Journal of Arrhythmia·Akihiko NogamiUNKNOWN JCS/JHRS Joint Working Group

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