Predictors and Long-Term Outcome of Ablation of Discrete Pre-potentials in Patients With Idiopathic Ventricular Arrhythmias Originating From the Aortic Sinuses of Valsalva

Hui-Qiang Wei; Xiao-Gang Guo; Gong-Bu Zhou; Qi Sun; Jian-Du Yang; Hai-Yang Xie; Jackson Liang; Shu Zhang; Shulin Wu; Jian Ma

doi:10.3389/fcvm.2021.767514

Predictors and Long-Term Outcome of Ablation of Discrete Pre-potentials in Patients With Idiopathic Ventricular Arrhythmias Originating From the Aortic Sinuses of Valsalva

Front Cardiovasc Med. 2021 Dec 7:8:767514. doi: 10.3389/fcvm.2021.767514. eCollection 2021.

Authors

Hui-Qiang Wei^{1

2}, Xiao-Gang Guo², Gong-Bu Zhou³, Qi Sun², Jian-Du Yang², Hai-Yang Xie², Jackson Liang⁴, Shu Zhang², Shulin Wu¹, Jian Ma²

Affiliations

¹ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Cardiology, Peking University Third Hospital, Beijing, China.
⁴ Division of Cardiovascular Medicine, Electrophysiology Service, University of Michigan Health System, Ann Arbor, MI, United States.

Abstract

Background: The predictability and long-term outcome of the discrete pre-potential (DPP) of idiopathic ventricular arrhythmias (VAs) arising from the aortic sinuses of Valsalva (ASV) have not been fully identified. Methods: Of 687 consecutive patients undergoing ablation of outflow tract VAs, there were 105 (15.3%) patients with VAs originating from the ASV region who were included. Detailed mapping was performed within the ASV in all patients. Electrocardiographic, electrophysiological parameters, and long-term success rate were compared between patients with and without the DPPs. Results: A DPP was recorded in 67 of 105 (63.8%) patients, including 38 left sinus of Valsalva (LSV)-VAs (38/105, 36.2%) and 29 right sinus of Valsalva (RSV)-VAs (29/105, 27.6%). The patients with DPPs had wider QRS duration (152 ± 17 vs. 145 ± 14 ms, p < 0.001). The average of earliest activation time was significantly earlier in patients with DPPs (-38.6 ± 8.5 vs. -27.7 ± 5.7 ms, p < 0.001). Mean time from the first lesion to elimination of VAs was shorter in patients with DPPs (2.3 ± 2.1 s vs. 4.9 ± 1.0 s, p < 0.001). A stepwise logistic multivariable analysis identified only younger age as a significant predictor of DPP (age ≤ 35.5 years predicted DPP with 92.9% positive predictive value). During a follow-up duration of 42.5 ± 22.3 months, 63 (94.0%) patients with DPPs and 30 (78.9%) patients without DPPs remained free of recurrent VAs (p = 0.027). Conclusion: Discrete pre-potentials were observed in 63.8% of patients with VAs arising from the ASV. Ablation in patients with DPPs was associated with higher long-term success. DPPs were seen more commonly in younger (age ≤ 35.5 years) patients.

Keywords: catheter ablation; discrete pre-potential; outcome; sinus of Valsalva; ventricular arrhythmia.