Ablation of Premature Ventricular Contractions With Prepotentials Mapped Inside Coronary Cusps: When to Go Infra-Valvular?
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Concerns Regarding “Ablation of Premature Ventricular Contractions With Prepotentials Mapped Inside Coronary Cusps: When to Go Infra-Valvular?”
- Volume 36Issue 4Journal of Cardiovascular Electrophysiology
- pages: 913-914
- First Published online: February 14, 2025
Youmei Shen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorLei Wang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorNing Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorLinlin Wang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorYajun Wang
Division of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, China
Search for more papers by this authorQian Pan
Division of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, China
Search for more papers by this authorLei Li
Division of Cardiology, Affiliated Wuxi Hospital of Nanjing University of Chinese Medicine, Wuxi, China
Search for more papers by this authorXiangwei Ding
Division of Cardiology, Jiangsu Taizhou People's Hospital, Taizhou, China
Search for more papers by this authorZhoushan Gu
Division of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
Search for more papers by this authorFei Li
Division of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Xuzhou, China
Search for more papers by this authorWeizhu Ju
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorMingfang Li
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorHongwu Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorGang Yang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorKai Gu
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorCorresponding Author
Hailei Liu
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Correspondence: Hailei Liu ([email protected])
Search for more papers by this authorMinglong Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorYoumei Shen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorLei Wang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorNing Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorLinlin Wang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorYajun Wang
Division of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, China
Search for more papers by this authorQian Pan
Division of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, China
Search for more papers by this authorLei Li
Division of Cardiology, Affiliated Wuxi Hospital of Nanjing University of Chinese Medicine, Wuxi, China
Search for more papers by this authorXiangwei Ding
Division of Cardiology, Jiangsu Taizhou People's Hospital, Taizhou, China
Search for more papers by this authorZhoushan Gu
Division of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
Search for more papers by this authorFei Li
Division of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Xuzhou, China
Search for more papers by this authorWeizhu Ju
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorMingfang Li
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorHongwu Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorGang Yang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorKai Gu
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this authorCorresponding Author
Hailei Liu
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Correspondence: Hailei Liu ([email protected])
Search for more papers by this authorMinglong Chen
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Search for more papers by this author*Y. Shen and L. Wang contributed equally as first authors.
ABSTRACT
Background
Discrete prepotentials (DPPs) mapped inside aortic sinuses of Valsalva (ASVs) are deemed as reliable targets for ablation of premature ventricular contractions (PVCs). Nevertheless, ablation may still fail, necessitating further investigation. This study aimed to investigate the electrophysiological features and ablation approaches for PVCs with failed ablation inside ASVs, despite identified DPPs.
Methods and Results
Patients undergoing PVCs ablation requiring left ventricular outflow tract mapping were consecutively enrolled at six centers. Inclusion criteria comprised the presence of reproducible DPPs in ASVs and the earliest activation inside ASVs preceding the left ventricle. Patients were divided into ASV and non-ASV groups based on ablation outcomes within ASVs. Of 780 assessed patients, 40 (age 47.5 ± 19.4; 17 males) were included in the final analysis, with 10 in the non-ASV group. The interval from DPPs to QRS onset (DPP-QRS) in the ASV group significantly exceeded that in the non-ASV group (44.3 ± 6.7 ms vs. 15.0 ± 5.0 ms, p < 0.001). A DPP-QRS interval < 25 ms perfectly differentiated non-ASV from ASV cases. Successful ablation beneath ASVs was achieved in all non-ASV patients, despite the local potential preceding the QRS onset by only 2.3 ± 8.0 ms. In the non-ASV group, the distance between locations of targets and DPPs was 13.3 ± 4.2 mm, negatively correlated with the DPP-QRS interval (R2 = 0.618, p = 0.007). Over a 22-month follow-up, one patient in the non-ASV group had recurrence.
Conclusion
DPPs mapped inside ASVs, despite being the earliest sites, do not necessarily represent PVCs targets. An infra-valvular approach is suggested with a DPP-QRS interval < 25 ms.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Supporting Information
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