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Catheter ablation of ventricular arrhythmias originating from the junction of the pulmonary sinus cusp via a nonreversed U curve approach

  • Xiaonan Dong
    Affiliations
    Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
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  • Qi Sun
    Affiliations
    Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
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  • Min Tang
    Correspondence
    Address reprint requests and correspondence: Dr. Min Tang, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
    Affiliations
    Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Shu Zhang
    Affiliations
    Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
    Search for articles by this author

      Background

      Ventricular arrhythmias (VAs) can originate from the pulmonary sinus cusp, and reversed U curve ablation has been highly efficient treatment.

      Objective

      The purpose of this study was to clarify the characteristics of VAs originating from the pulmonary sinus junction (PSJ): left cusp–anterior cusp (LC-AC), right cusp–left cusp (RC-LC), and right cusp–anterior cusp (RC-AC).

      Methods

      One hundred twenty-five consecutive patients with right ventricular outflow (RVOT)-type VAs were enrolled in the study and analyzed.

      Results

      Seventeen RVOT-type VAs (13.6%) had an anatomic origin at the PSJ (9 at LC-AC, 6 at RC-LC, 4 at RC-AC). For PSJ-VA patients, the earliest activation site was identified at the PSJ 22.65 ± 2.47 mm above the pulmonary sinus base and preceded QRS onset by 35.7 ± 12.7 ms (P <.001). Fourteen of the 17 PSJ-VA patients underwent successful ablation via a nonreversed U curve after failed reversed U curve ablation. The bipolar proximal potential was earlier, equal to, or later than the distal potential when the reversed U curve catheter tip was positioned at the bottom, middle, or junction region of individual sinus. Electrocardiographic analysis revealed a lower amplitude of RC-AC than LC-AC and RC-LC VAs (P <.001).

      Conclusion

      The PSJ is a nonrare but distinct origin of RVOT-type VAs. The nonreversed U curve approach is a more feasible alternative for PSJ-VAs than the reversed U curve approach.

      Keywords

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