Catheter ablation of idiopathic premature ventricular contractions and ventricular tachycardias originating from right ventricular septum

PLoS One. 2013 Jun 25;8(6):e67038. doi: 10.1371/journal.pone.0067038. Print 2013.

Abstract

Background: Idiopathic premature ventricular contractions (PVCs) and ventricular tachycardias (IVTs) originating from the subtricuspid septum and near the His bundle have been reported. However, little is known about the prevalence, distribution, electrocardiographic characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for the ventricular arrhythmias arising from the right ventricular (RV) septum. This study aimed to investigate electrocardiographic characteristics and effects of RFCA for patients with symptomatic PVCs/IVTs, originating from the different portions of the RV septum.

Methodology/principal findings: Characteristics of body surface electrocardiogram and electrophysiologic recordings were analyzed in 29 patients with symptomatic PVCs/IVTs originating from the RV septum. Among 581 patients with PVCs/IVTs, the incidence of ventricular arrhythmias originating from the RV septum was 5%. Twenty (69%) had PVCs/IVTs from the septal portion of the tricuspid valvular RV region (3 from superoseptum, 15 from midseptum, 2 from inferoseptum), and 9 (31%) from the septal portion of the basal RV (1 from superoseptum, 4 from midseptum, 4 from inferoseptum). There were different characteristics of ECG of PVCs/VT originating from the different portions of the RV septum. Twenty-seven of 29 patients with PVCs/IVTs arising from the RV septum were successfully ablated (93.1% acute success).

Conclusions/significance: ECG characteristics of PVCs/VTs originating from the different portions of the RV septum are different, and can help regionalize the origin of these arrhythmias. The septal portion of the tricuspid valvular RV region was the preferential site of origin. RFCA was effective and safe for the PVCs/IVTs arising from the RV septum.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catheter Ablation*
  • Electrocardiography
  • Electrophysiological Phenomena
  • Female
  • Humans
  • Male
  • Middle Aged
  • Tachycardia, Ventricular / physiopathology*
  • Tachycardia, Ventricular / therapy*
  • Time Factors
  • Treatment Outcome
  • Ventricular Premature Complexes / physiopathology*
  • Ventricular Premature Complexes / therapy*
  • Ventricular Septum / physiopathology*
  • Young Adult

Grants and funding

This study is supported by Wenzhou Municipal Science and Technology Commission (Grant No. Y2008086) and Electrophysiology and Cardiac Pacing Association of Zhejiang Medical Association (Grant No. 2011ZYC-A27), China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.