Ventricular tachycardias arising from the aortic sinus of Valsalva: An under-recognized variant of left outflow tract ventricular tachycardia

OBJECTIVES To describe a normal heart left bundle branch block, inferior ax is ventricular tachycardia (VT), that could not be ablated from the right o r left ventricular outflow tracts. BACKGROUND Whether these VTs are epicardial and can be identified by a spec ific electrocardiographic pattern is unclear. METHODS Twelve patients with normal heart left bundle branch block, inferio r axis VT and previously failed ablation were included in this study. Toget her with mapping in the right and left ventricular outflow tracts, we obtai ned percutaneous epicardial mapping in the first five patients and performe d aortic sinus of Valsalva mapping in all patients. RESULTS No adequate pace mapping was observed in the right and left ventric ular outflow tracts. Earliest ventricular activation was noted in the epica rdium and the aortic cusps. All patients were successfully ablated from the aortic sinuses of Valsalva (95% CI 0% to 18%). The electrocardiographic pa ttern associated with this VT was left bundle branch block, inferior axis a nd early precordial transition with Rs or R in V-2 or V-3. Ventricular tach ycardia from the left sinus had rS pattern in lead I, and VT from the nonco ronary sinus had a notched R wave in lead I. None of the patients had compl ications and all remained arrhythmia-free at a mean follow-up of 8 +/- 2.6 months. CONCLUSIONS Normal heart VT with left bundle branch block, inferior axis an d early precordial transition can be ablated in the majority of patients fr om either the left or the noncoronary aortic sinus of Valsalva. (J Am Coil Cardiol 2001;37:1408-14) (C) 2001 by the American College of Cardiology.