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Incidence of Periaortic Sustained Ventricular Tachycardias Long After Surgical Aortic Valve Replacements
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  • Kentaro Goto,
  • Yuichi Ono,
  • Yuki Osaka,
  • Asami Suzuki,
  • Ken Kurihara,
  • Takeshi Someya,
  • Yoshihide Takahashi,
  • Kenichiro Otomo,
  • Masahiko Goya,
  • Tetsuo Sasano
Kentaro Goto
Ome Municipal General Hospital
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Yuichi Ono
Ome Municipal General Hospital
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Yuki Osaka
Ome Municipal General Hospital
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Asami Suzuki
Ome Municipal General Hospital
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Ken Kurihara
Ome Municipal General Hospital
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Takeshi Someya
Ome Municipal General Hospital
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Yoshihide Takahashi
Tokyo Medical and Dental University
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Kenichiro Otomo
Ome Municipal General Hospital
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Masahiko Goya
Tokyo Medical and Dental University
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Tetsuo Sasano
Tokyo Medical and Dental University
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Abstract

Objective: To investigate the incidence, risk factors and clinical characteristics of periaortic VTs after AVR. Background: The periaortic region is the origin of some ventricular tachycardias (VTs) after aortic valve replacement (AVR). However, the clinical characteristics of periaortic VTs after AVR are yet to be clarified. Methods: We retrospectively analyzed clinical courses of 109 patients who had undergone surgical AVR (SAVR) without other structural heart diseases between April 2009 and Jun 2019 and evaluated the incidence and characteristics of periaortic VTs after SAVR. Results: Three patients (2.8%) developed periaortic VTs after SAVR. The average duration of onset was 12.3±6.6 years. All VTs arose from the inferior axis; they included both left and right bundle branch block configuration (LBBB and RBBB). Two patients underwent cardiac magnetic resonance imaging; late gadolinium enhancement (LGE) was observed in the mid-layer of the left ventricle basal anteroseptal wall in both cases. Patients with periaortic VTs had significantly wider interventricular septum, lower left ventricular ejection fraction (LVEF), larger LV diameter at systole, and higher positive rates of signal-averaged ECG and non-sustained VTs on Holter. On ablation, local fragmented potentials with low voltage zones were observed in accordance with the distribution of LGE. Multiple VTs originating from the periaortic region were provoked in the sessions. Conclusions: Periaortic VTs long after surgical AVR are not rare, and arrhythmia risk stratification, including that by signal averaged electrocardiogram (SAECG), Holter, and cardiac magnetic resonance imaging (MRI) should be considered.