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Ventricular Arrhythmias Arising From the Left Ventricular
Outflow Tract Below the Aortic Sinus CuspsCLINICAL
PERSPECTIVE
by Feifan Ouyang, Shibu Mathew, Shulin Wu, Masashi Kamioka, Andreas Metzner,
Yumei Xue, Weizhu Ju, Bing Yang, Xianzhang Zhan, Andreas Rillig, Tina Lin, Peter
Rausch, Sebastian Deiß, Christine Lemes, Tobias Tönnis, Erik Wissner, Roland
Richard Tilz, Karl-Heinz Kuck, and Minglong Chen
Circ Arrhythm Electrophysiol
Volume 7(3):445-455
June 17, 2014
Copyright © American Heart Association, Inc. All rights reserved.
Fluoroscopic views (right anterior oblique [RAO] and left anterior oblique [LAO]) demonstrating
transseptal puncture through the anteroinferior fossa ovalis in a patient with left ventricular
outflow tract ventricular arrhythmias.
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
Fluoroscopic views (right anterior oblique [RAO] and left anterior oblique [LAO]) showing the
mapping catheter in the left ventricular outflow tract (LVOT) below the right coronary cusp (RCC;
A and B) and left coronary cusp (LCC; C and D).
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
Electroanatomic mapping of the aortic root and left ventricle (LV) via only transaortic approach
(A and B), and a combination of transaortic and transseptal approaches (C and D).
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
Activation mapping, fluoroscopy, and 3-dimensional mapping in a 42-year-old man with 2
previous failed ablation attempts in the right ventricular outflow tract (RVOT) and aortic-mitral
continuity.
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
Fluoroscopy, activation, and 3-dimensional mapping in a 34-year-old man with previous failed
ablation attempts.
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
Typical ECGs from 3 patients with ventricular arrhythmias (VAs) originating from the left
ventricular outflow tract (LVOT) below the left coronary cusp (LCC), LCC/right coronary cusp
(RCC) junction, and the RCC. A, ECG recording from a 15-year-old woman in whom the VA origin
was located below the LCC, with 2 previous failed ablation attempts in the great cardiac vein,
LVOT, and LCC; B, ECG recording from a 60-year-old woman with VAs originating from below the
RCC/LCC junction; C, ECG recording from a 47-year-old woman with VAs originating below the
RCC. Note that (1) II, III, and aVF have high amplitudes and there is QS morphology in aVR and
aVL during clinical arrhythmias; (2) absolute values of the R-wave amplitudes in II, III and aVF,
and the Q-wave amplitude in aVR and aVL are marked on the surface ECG; and (3) there is no S
wave in V5 and V6, with early transition in the precordial leads before V3.
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.
A to F, Complete anatomic mapping of the right ventricle (RV), left ventricle (LV), aorta root, and
distal part of the coronary sinus (CS) in various views in patients with left ventricular summit
(LVS) ventricular arrhythmias.
Feifan Ouyang et al. Circ Arrhythm Electrophysiol.
2014;7:445-455
Copyright © American Heart Association, Inc. All rights reserved.