Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity

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Catheter ablation is an established treatment strategy for outflow tract ventricular arrhythmias (OT‐VAs), with overall good success rates.1 In patients with OT‐VAs, the presence of an R wave pattern break in lead V2 (PBV2) has been suggested to indicate an origin close to the anterior interventricular sulcus, which is anatomically opposite to the unipolar lead V26 (Fig. 1). The anterior interventricular sulcus is the epicardial longitudinal groove that runs between the right and the left ventricle, and contains major coronary vessels (i.e., left anterior descending [LAD] coronary artery and anterior interventricular vein [AIV]) and a thick layer of epicardial fat.7 As such, catheter ablation of OT‐VAs arising in proximity of the anterior interventricular sulcus is particularly challenging. In this study, we sought to characterize the anatomic origin, electrophysiological features, and outcomes of catheter ablation of OT‐VAs with a PBV2.
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