Ablation of Idiopathic Ventricular Tachycardia with a Left Bundle-Branch Block Morphology Originating from the Pulmonary Artery

• Published in: Journal of Arrhythmia 2006, Vol.22 (3), p.180-186
• Main Authors: Hiroshi Ogi, Yukiko Nakano, Noboru Oda, Miwa Miyoshi, Kazuaki Chayama, Ken Ishibashi, Yuko Hirai, Tomokazu Okimoto
• Format: Article
• Language: Japanese
• ISSN: 1880-4276

We successfully performed radiofrequency catheter ablation (RFCA) in 2 cases involving patients with idiopathic ventricular tachycardias (VTs) and premature ventricular contractions (PVCs) originating from the pulmonary artery (PA). The QRS morphology of the VTs and PVCs in the two cases exhibited a left bundle-branch block (LBBB) morphology with an inferior axis. Activation and pace mappings were performed in the right ventricular outflow tract (RVOT) and above the pulmonary valve to determine the origin of the VTs and PVCs. In both cases, the earliest ventricular activation was recorded in the PA above the pulmonary valve. Applications of radiofrequency current at those sites in the PA resulted in the elimination and noninducibility of the VT and PVC. During the follow-up, the VT or PVC did not recur without any antiarrhythmic drug administration. [Introduction] Radiofrequency catheter ablation (RFCA) is an established curative therapy for idiopathic ventricular tachycardias (VTs) or symptomatic premature ventricular contractions (PVCs) with a left bundle-branch block (LBBB) morphology originating from the outflow tract (OT) in structurally normal hearts. Most of those arrhythmias have their origin located on the septal side of the right ventricular outflow tract (RVOT). However, some originate from the free wall of the RVOT, left ventricular outflow tract (LVOT) or aortic sinus cusp (ASC). Additionally, several reports have indicated that some idiopathic VTs originate from the pulmonary artery (PA) and can be ablated successfully in the PA. In this report, we discuss 2 cases with idiopathic VTs originating from the PA.