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Three-Dimensional Visualization of Bidirectional Preferential Pathway Conduction of Premature Ventricular Contractions Originating from the Outflow Tract
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  • Seina Yagyu,
  • Koichi Nagashima,
  • Sayaka Kurokawa,
  • Yuji Wakamatsu,
  • Naoto Otsuka,
  • Satoshi Hayashida,
  • Shu Hirata,
  • Yasuo Okumura
Seina Yagyu
Nihon University School of Medicine
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Koichi Nagashima
Nihon University School of Medicine
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Sayaka Kurokawa
Nihon University School of Medicine
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Yuji Wakamatsu
Nihon University School of Medicine Graduate School of Medicine
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Naoto Otsuka
Nihon University School of Medicine
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Satoshi Hayashida
Nihon University School of Medicine Graduate School of Medicine
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Shu Hirata
Nihon University School of Medicine
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Yasuo Okumura
Nihon University School of Medicine
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Abstract

Introduction: Presence of preferential pathway conduction is mostly detected as fractionated presystolic potentials preceding the QRS onset during premature ventricular contractions (PVCs) and late potentials during sinus rhythm (SR), but the electrophysiologic mechanisms and significance of these potentials have not been fully clarified. We describe a PVC case series in which the preferential pathway conduction was 3-dimensionaly visualized by coherent mapping with the conduction velocity vector. Methods: Five PVCs (2 from the left coronary cusp, 2 from the commissure of the left and right coronary cusps, and 1 from the pulmonary artery) in 4 patients for which a fractionated presystolic potential during the PVCs and late potential during SR were recorded at the successful ablation site were reviewed, and 3-dimensional coherent activation maps with the conduction velocity vector during the PVCs and SR were reconstructed. Results: At the successful ablation site, an “M”-shaped discrete presystolic-potential and “W”-shaped discrete late-potential were recorded in all patients. The configuration of the flipped electrogram of the presystolic-potential nearly matched that of the electrogram exhibiting the late-potential. We created coherent activation maps annotating the onset of the presystolic potentials during the PVCs, and the offset of the late potentials during SR, which suggested bidirectional conduction of the preferential pathway connecting the PVC origin to the myocardium. Conclusion: In this case series, the M-shaped presystolic potential and W-shaped late potential were reversely matched. These reverse potentials, and the coherent activation vector maps during PVCs and SR suggested bidirectional conduction of the preferential pathway in opposite directions.

Peer review status:Published

22 Sep 2020Submitted to Journal of Cardiovascular Electrophysiology
23 Sep 2020Submission Checks Completed
23 Sep 2020Assigned to Editor
26 Sep 2020Reviewer(s) Assigned
22 Oct 2020Review(s) Completed, Editorial Evaluation Pending
26 Oct 2020Editorial Decision: Revise Minor
31 Dec 20201st Revision Received
09 Jan 2021Submission Checks Completed
09 Jan 2021Assigned to Editor
09 Jan 2021Reviewer(s) Assigned
09 Jan 2021Review(s) Completed, Editorial Evaluation Pending
11 Jan 2021Editorial Decision: Revise Minor
09 Feb 20212nd Revision Received
09 Feb 2021Submission Checks Completed
09 Feb 2021Assigned to Editor
09 Feb 2021Reviewer(s) Assigned
12 Feb 2021Review(s) Completed, Editorial Evaluation Pending
13 Feb 2021Editorial Decision: Revise Minor
17 Feb 20213rd Revision Received
23 Feb 2021Submission Checks Completed
23 Feb 2021Assigned to Editor
23 Feb 2021Review(s) Completed, Editorial Evaluation Pending
05 Mar 2021Editorial Decision: Accept
08 Apr 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15014