Ventricular Tachycardia from the Aortic Cusps: Localization and Ablation

摘要

Repetitive monomorphic VT occurring in the absence of structural heart disease typically originates in the outflow tract regions of the right and less commonly the left ventricles [1-8]. An unusual origin for this tachycardia in the outflow tract region is the cusps of the aortic valve. Importantly, this site of origin may be more common than previously recognized [9, 10]. This review will 1) characterize the anatomic relationship of the pulmonic and aortic valves, 2) identify surface electrocardiographic clues that suggest an origin from the aortic cusps and 3) describe the use of magnetic electroanatomic recording and intracardiac echo for identifying precise catheter position when mapping and ablating in the aortic cusp region and finally 4) describe an ablation and energy delivery strategy at these sites which are in close proximity to the ostium of the coronary arteries.