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Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias.

Abstract：

OBJECTIVES:This study sought to compare and contrast the clinical and electrophysiological characteristics of outflow tract arrhythmias. BACKGROUND:Idiopathic ventricular outflow tract arrhythmias manifest clinically in 3 forms: 1) paroxysmal sustained monomorphic ventricular tachycardia (SMVT), 2) repetitive nonsustained ventricular tachycardia (NSVT), or 3) premature ventricular contractions (PVCs). Although these arrhythmias have a similar site of origin, it is unknown whether they share a common mechanism or similar clinical features. METHODS:A total of 127 patients (63 female [50%], mean age 51 +/- 15 years) were evaluated for outflow tract arrhythmias. RESULTS:A total of 36 (28%) presented with the index clinical arrhythmia of SMVT, 46 (36%) with NSVT, and 45 (35%) with PVCs. The sites of origin of the arrhythmias were similar among the 3 groups, occurring in the right ventricular outflow tract in 82%. Sustained ventricular tachycardia was more likely to be induced during exercise in the SMVT (10 of 15 patients [67%]) than NSVT or PVCs groups (p < 0.01). Sustained outflow tract ventricular tachycardia was induced at electrophysiology study in 78% of SMVT patients, 48% of NSVT patients, and 4% of PVCs patients. Adenosine was similarly effective in all 3 groups (p = NS). CONCLUSIONS:Patients with outflow tract arrhythmias can be differentiated based on the subtype of arrhythmia. However, the observation that approximately 50% of patients with NSVT and approximately 5% of patients with PVCs have inducible sustained ventricular tachycardia that behaves in an identically unique manner to those who present with sustained ventricular tachycardia (e.g., adenosine-sensitive) suggests that rather than representing distinct entities, outflow arrhythmias may be considered a continuum of a single mechanism.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kim RJ,Iwai S,Markowitz SM,Shah BK,Stein KM,Lerman BB

doi

10.1016/j.jacc.2007.01.085

subject

Has Abstract

pub_date

2007-05-22 00:00:00

pages

2035-43

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(07)00838-8

journal_volume

pub_type

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Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias.