Structured 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.
(239 words)
Keywords: periaortic, ventricular tachycardia, aortic valve
replacement, arrhythmia, long-term