Author + information
- Received July 15, 2004
- Revision received October 20, 2004
- Accepted December 6, 2004
- Published online March 15, 2005.
- Hiroshi Tada, MD*,* (, )
- Sachiko Ito, MD*,
- Shigeto Naito, MD*,
- Kenji Kurosaki, MD*,
- Shoichi Kubota, MD§,
- Aiko Sugiyasu, MD§,
- Taketsugu Tsuchiya, MD†,
- Kohei Miyaji, MD*,
- Minoru Yamada, MD*,
- Yasunori Kutsumi, MD‡,
- Shigeru Oshima, MD*,
- Akihiko Nogami, MD§ and
- Koichi Taniguchi, MD, FACC*
- ↵*Reprint requests and correspondence:
Dr. Hiroshi Tada, Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma 371-0004, Japan
Objectives We sought to clarify the prevalence and characteristics of idiopathic ventricular tachycardia or premature ventricular contraction originating from the mitral annulus (MAVT/PVC).
Background Recent case reports have presented patients with MAVT/PVC.
Methods Electrocardiographic (ECG) characteristics and the results of electrophysiologic investigation and radiofrequency catheter ablation (RFCA) were analyzed in 352 patients with symptomatic idiopathic ventricular tachycardia (IVT)/premature ventricular contraction (PVC).
Results Nineteen cases of IVT/PVC (5%) represented MAVT/PVC. Of these, 11 (58%) originated from the anterolateral portion of the mitral annulus (AL-MAVT/PVC), and 2 (11%) arose from the posterior portion (Pos-MAVT/PVC). The remaining six cases of MAVT/PVC (31%) had posteroseptal origin (PS-MAVT/PVC). In all patients, an S-wave was present in lead V6. The QRS polarity in inferior leads and leads I and aVL was useful for differentiating AL-MAVT/PVC from Pos-MAVT/PVC or PS-MAVT/PVC. The Pos-MAVT/PVC had an Rs pattern in lead I and an R pattern in lead V1, whereas PS-MAVT/PVC invariably had an R pattern in lead I and a negative QRS component in lead V1. The AL-MAVT/PVC and Pos-MAVT/PVC showed a longer QRS duration than the PS-MAVT/PVC (p < 0.001), and all had late-phase “notching” of the QRS complex in inferior leads. In all patients, RFCA eliminated MAVT/PVC, with no recurrences during follow-up for 21 ± 15 months.
Conclusions Mitral annular VT/PVC is a rare but distinct subgroup of IVT/PVC. MAVT/PVC origin could be determined by ECG analysis. The AL and PS sites of the MA were preferential.
- Received July 15, 2004.
- Revision received October 20, 2004.
- Accepted December 6, 2004.
- American College of Cardiology Foundation