Discrete prepotential as an indicator of successful ablation in patients with coronary cusp ventricular arrhythmia

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Abstract

Background: Although coronary cusp (CC) ventricular arrhythmia (VA) can be treated by catheter ablation, reliable indicators of successful ablation sites have not been fully identified. Methods and Results: This study comprised 392 patients undergoing radiofrequency catheter ablation for outflow tract-VA at 3 institutions from January 2007 to August 2012. The successful ablation site was on the left CC or right CC in 35 (8.9%) of the 392 patients. In 9 (26%) of these 35 patients, a discrete prepotential was recognized, 5 of whom had left CC-VAs and 4 of whom had right CC-VAs. Radiofrequency catheter ablation was successful at the site of the prepotential in all 9 of these patients. The duration of the isoelectric line between the end of the discrete prepotential and the onset of the ventricular electrogram was 27±13 ms. The time from onset of the discrete prepotential at the successful ablation site on the CC to the QRS onset (activation time) was 69±20 ms (range, 50-98 ms). Pace mapping was graded as excellent at the successful ablation site in only 1 patient. No discrete prepotential was recorded in any successful right outflow tract-VA ablation case in this study. Conclusions: A discrete prepotential was seen in 9 (26%) of 35 patients with CC-VA. In left and right CC-VA, the site of a discrete prepotential with ≥50 ms activation time may indicate a successful ablation site. © 2013 American Heart Association, Inc.

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Hachiya, H., Yamauchi, Y., Iesaka, Y., Yagishita, A., Sasaki, T., Higuchi, K., … Hirao, K. (2013). Discrete prepotential as an indicator of successful ablation in patients with coronary cusp ventricular arrhythmia. Circulation: Arrhythmia and Electrophysiology, 6(5), 898–904. https://doi.org/10.1161/CIRCEP.113.000157

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