Site-Specific Arrhythmogenesis in Structurally Normal Heart of Non-Brugada Patients with Ventricular Arrhythmias Originating from Ventricular Outflow Tract

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  • Ozawa Tomoya
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Ito Makoto
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Itoh Hideki
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Nakazawa Yuko
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Sugimoto Yoshihisa
    Department of Medical Informatics, Shiga University of Medical Science
  • Yao Takenori
    Okamura Memorial Hospital
  • Miyamoto Akashi
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Ashihara Takashi
    Department of Cardiovascular Medicine, Shiga University of Medical Science
  • Horie Minoru
    Department of Cardiovascular Medicine, Shiga University of Medical Science

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Background: Ventricular fibrillation (VF) and/or polymorphic ventricular tachycardia (PVT) may be initiated by premature ventricular contractions (PVCs) from right ventricular outflow tract (RVOT). Methods: We evaluated the number and the location of PVCs/VTs foci of the 87 patients (mean age 43 y, 54 females) who underwent radiofrequency ablation (RF) to the RVOT or coronary cusp without structural heart disease or Brugada syndrome. Results: Endocardial mapping showed no scar or low voltage area from RVOT during sinus rhythm. Seventy-five patients had monomorphic PVCs/VTs and exhibited no PVT or VF during both Holter monitors and RF. In 12 patients with PVCs of different morphologies, 9 patients had multiple PVCs originated from only RVOT septal area, and showed no PVT/VF. However, the other 3 patients had PVCs from both RVOT septum and free wall origins, and exhibited PVT and VF. Moreover, PVTs/VFs were triggered by spontaneous PVCs from only free wall foci of RVOT in those 3 patients. Conclusions: PVCs from free wall RVOT origin may induce malignant VT/VF in patients with idiopathic RVOT tachy-arrhythmias from multiple foci of both septal and free wall areas. Site-specific arrhythmogenesis presents in such patients.

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