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• W4377014981 abstract "Ventricular arrhythmias (VA) have been noted to arise from the basal inferoseptal portion of the LV, also known as the posterior-superior process of the LV (PSP). Data regarding ablation in this patient group are sparse. This study sought to determine the incidence of PSP VAs and to describe ablation characteristics and outcomes. A retrospective cohort study including all patients undergoing VA ablation for PVCs and/or focal NSVT/VT from January 2017 to February 2022 was conducted at a single center. Patients undergoing ablation for scar-related reentrant VT were excluded. Clinical data and outcomes were analyzed for those patients with PSP VAs. A total of 267 patients underwent VA ablation. Twenty (7.5%) had VAs ablated from the PSP (90% male, age 60.6 ± 15.8 years, LVEF 45 ± 13%). Of these, 11 were idiopathic (5.1% of all idiopathic VAs) and 9 were associated with structural heart disease. In the idiopathic group, 3 had PVC-induced cardiomyopathy. ECG predominantly showed RBBB morphology with positive concordance, small s wave in V6, and left superior axis. In two patients, a LBBB morphology was seen with early transition in V2. Four had a second, infrequent PVC with LBBB morphology, left superior axis, and “reverse V2 pattern break.” (Figure, top) All 20 patients were ablated in the PSP. Two required additional ablation in the right atrium (RA), and both had the two PVC morphologies described above. In 1 patient, after ablation in the PSP, the PVC morphology changed from RBBB to LBBB in V1 and was terminated after ablation in the coronary sinus and middle cardiac vein (CS/MCV). Four patients developed transient junctional rhythm during the procedure (3 with ablation in the PSP, 1 with ablation in the RA). AV block was not observed, but cryoablation of the RA was required in 1 patient. Ablation was acutely successful in all patients. In the 18 patients with follow-up, 14 (78%) had long-term PVC suppression. In 3 patients with recurrence, the recurrent PVC had a different morphology than the targeted PVC (Figure, top: 2-7) In patient 4, the recurrent PVC was only seen after ablation. PSP VAs may be more prevalent than previously reported. Multiple PVC morphologies with a left superior axis were seen in a large proportion of patients, suggesting an intramural focus with variable exits in the region. The PSP has anatomic relationships to the RA, cardiac crux/CS/MCV, and the AV node (Figure, bottom), and a multifocal approach may be needed for ablation success." @default.
• W4377014981 created "2023-05-19" @default.
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• W4377014981 date "2023-05-01" @default.
• W4377014981 modified "2023-09-28" @default.
• W4377014981 title "PO-05-102 CHARACTERISTICS AND ABLATION OF VENTRICULAR ARRHYTHMIAS FROM THE POSTERIOR SUPERIOR PROCESS OF THE LEFT VENTRICLE" @default.
• W4377014981 doi "https://doi.org/10.1016/j.hrthm.2023.03.1353" @default.
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