Ventricular Arrhythmias Originating From Different Portions of the Anterior Interventricular Vein: Electrocardiographic Characteristics and Ablation Strategy.

INTRODUCTION

The anterior interventricular vein (AIV) is an important and recognized source of ventricular arrhythmias (VAs) within the coronary venous system. However, no studies have specifically investigated the electrocardiographic (ECG) characteristics and ablation strategies for VAs originating from the AIV.

OBJECTIVE

This study aimed to investigate the ECG characteristics and optimal ablation strategies for VAs originating from the AIV.

METHODS

This study comprised 51 patients with VAs originating from AIV.

RESULTS

The 51 patients were divided into proximal (40 cases) and non-proximal groups (11 cases) based on their target sites in AIV. Successful ablation was achieved in 82.5% (33/40) patients in the p-AIV group and 72.7% (8/11) patients in the np-AIV group. By ECG analysis, we found a deeper S-wave in lead I and a lower R-wave in lead V1 and V2, indicating a more distal origin in AIV. R/S < 0.10, R < 0.325 mV, and R/S < 0.20 were excellent differential indices for predicting VAs originating from the np-AIV, with the predictive value of 91.3%, 95.1%, and 95.8%, respectively. Ablation modalities, including conventional radiofrequency catheter ablation (RFCA) and guidewire ablation, have been applied in AIV VAs. Among successful cases, 87.8% of VAs were ablated by conventional RFCA and 12.2% by guidewire ablation. In the situation of an acute angle between the AIV and distal great cardiac vein (DGCV) or a thin AIV lumen, guidewire ablation should be prioritized over RFCA.

CONCLUSION

There were significant differences in the ECG characteristics of VAs at different portions of AIV. Guidewire ablation could be considered an alternative approach for treating AIV-originated VAs inaccessible to conventional ablation catheters.