Reappraisal and New Observations on Idiopathic Ventricular Arrhythmias Ablated From the Noncoronary Aortic Sinus

• Published in: JACC. Clinical electrophysiology 2023-08, Vol.9 (8), p.1279-1291
• Main Authors: Liao, Zili, Dai, Shimo, Nie, Zhenning, Song, Xudong, Huang, Xingfu, Wang, Jing, Yang, Fei, Liu, Xu, Du, Zhongpeng, Wei, Huiqiang, Liu, Fangzhou, Zhan, Xianzhang, Xue, Yumei, Yang, Pingzhen, Ma, Jian, Ouyang, Feifan, Ge, Junbo, Wu, Shulin
• Format: Article
• Language: English
• Subjects: aortic root; Arrhythmias, Cardiac - surgery; Bundle of His - surgery; Catheter Ablation; Heart Ventricles - surgery; His bundle; Humans; noncoronary sinus; Sinus of Valsalva - diagnostic imaging; Sinus of Valsalva - surgery; Tachycardia, Ventricular - surgery; ventricular arrhythmia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2023.01.028

The electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) from the noncoronary sinus (NCS) have not been fully described. This study sought to investigate electrophysiological characteristics and catheter ablation in patients with idiopathic NCS-VA. This study comprised 11 patients undergoing radiofrequency (RF) catheter ablation for idiopathic NCS-VA. Angiography was performed to confirm the origin in the aortic sinus before RF ablation. Clinical arrhythmias presented left bundle block/inferior axis morphology in all patients. QRS morphology of R’ and R/s’ pattern was dominantly found in lead III. Mapping in the right ventricle demonstrated the earliest ventricular activation (EVA) site at the His Bundle region, whereas mapping in the NCS demonstrated that the EVA preceded the activation at the His Bundle region by 12.1 ± 7.9 milliseconds. All VAs were successfully ablated in