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

Tamas Szili Torok, Lennar T J De Vries, Emin E. Özcan, Can Hasdemir, Zsuzsanna Kis, A. Kardos, Tamas GÉczy, Istvan Kovacs, Imre Benedek, Erik Oosterwerff, Astrid A. Hendriks, Muchtiar Khan, Sing Chien Yap

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)78-84
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Ventricular Premature Complexes
Catheter Ablation
Cardiac Arrhythmias
Atrioventricular Nodal Reentry Tachycardia
Electrophysiology
Electrocardiography

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways. / Szili Torok, Tamas; De Vries, Lennar T J; Özcan, Emin E.; Hasdemir, Can; Kis, Zsuzsanna; Kardos, A.; GÉczy, Tamas; Kovacs, Istvan; Benedek, Imre; Oosterwerff, Erik; Hendriks, Astrid A.; Khan, Muchtiar; Yap, Sing Chien.

In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 1, 01.01.2017, p. 78-84.

Research output: Contribution to journalArticle

Szili Torok, T, De Vries, LTJ, Özcan, EE, Hasdemir, C, Kis, Z, Kardos, A, GÉczy, T, Kovacs, I, Benedek, I, Oosterwerff, E, Hendriks, AA, Khan, M & Yap, SC 2017, 'Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways', Journal of Cardiovascular Electrophysiology, vol. 28, no. 1, pp. 78-84. https://doi.org/10.1111/jce.13098
Szili Torok, Tamas ; De Vries, Lennar T J ; Özcan, Emin E. ; Hasdemir, Can ; Kis, Zsuzsanna ; Kardos, A. ; GÉczy, Tamas ; Kovacs, Istvan ; Benedek, Imre ; Oosterwerff, Erik ; Hendriks, Astrid A. ; Khan, Muchtiar ; Yap, Sing Chien. / Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways. In: Journal of Cardiovascular Electrophysiology. 2017 ; Vol. 28, No. 1. pp. 78-84.
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AU - De Vries, Lennar T J

AU - Özcan, Emin E.

AU - Hasdemir, Can

AU - Kis, Zsuzsanna

AU - Kardos, A.

AU - GÉczy, Tamas

AU - Kovacs, Istvan

AU - Benedek, Imre

AU - Oosterwerff, Erik

AU - Hendriks, Astrid A.

AU - Khan, Muchtiar

AU - Yap, Sing Chien

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N2 - 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.

AB - 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.

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