Utility of local atrial electrogram pattern for predicting left main coronary artery anatomical distance during mapping in the left pulmonary sinus of valsalva.
BACKGROUND
Ablation of right ventricular outflow tract (RVOT) ventricular arrhythmia (VA) within the left pulmonary sinus of Valsalva (LPSV) may increase the risk of left main coronary artery (LMCA) injury.


PURPOSE
To delineate the anatomical characteristics between LMCA and LPSV and their association with atrial potential (AP) mapping in LPSV.


METHODS
A total of 104 consecutive patients with RVOT-VA undergoing cardiac-gated computed tomography coronary angiography (CTCA) after ablation were retrospectively analyzed.


RESULTS
The LMCA-LPSV anatomic relationship was classified into three types based on the CTCA measurements. Types 1 and 2 had a shorter LMCA-LPSV distance than that of type 3 (P < .001). The left atrial appendage (LAA)-LMCA distance and LAA-LPSV distance were associated with the incidence of AP in LPSV (odds ratio [OR] = 3.43, 95% confidence interval [CI]: 1.86-6.34, P < .001; OR = 1.196, 95% CI: 1.09-1.31, P < .001, respectively). Furthermore, the LMCA-LPSV distance showed a linear correlation with the LAA-LPSV distance (r2  = 0.93, P < .001). According to receiver operating characteristic (ROC) analysis, a LMCA-LPSV distance <5.4 mm could predict the possibility of AP during LPSV mapping (sensitivity 83%, specificity 81%, and area under the ROC curve 0.86).


CONCLUSIONS
The presence of AP in the LPSV may be useful to predict a short distance from the LPSV to the LMCA and to identify patients at higher risk of LMCA injury. This information may contribute to efficient and safe ablation in this area but should be confirmed in future studies.
['Dong|Xiaonan|X|', 'Tang|Min|M|', 'Sun|Qi|Q|0000-0003-2281-143X', 'Zhang|Shu|S|0000-0001-8660-7521']
D000200:Action Potentials D000368:Aged D000369:Aged, 80 and over D020517:Atrial Appendage D055424:Cardiac-Gated Imaging Techniques D017115:Catheter Ablation D000072226:Computed Tomography Angiography D017023:Coronary Angiography D003331:Coronary Vessels D022062:Electrophysiologic Techniques, Cardiac D005260:Female D006335:Heart Injuries D006339:Heart Rate D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D015203:Reproducibility of Results D012189:Retrospective Studies D012307:Risk Factors D012850:Sinus of Valsalva D017180:Tachycardia, Ventricular D016896:Treatment Outcome D018879:Ventricular Premature Complexes
coronary artery pulmonary sinus of Valsalva atrial potential anatomy catheter ablation