Novel electrophysiological criteria for septal ventricular outflow tract tachycardias requiring a sequential bilateral ablation

Chin Yu Lin, Fa Po Chung, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Jo Nan Liao, Ta Chuan Tuan, Tze Fan Chao, Yao Ting Chang, Yun Yu Chen, Abigail Louise D. Te, Shinya Yamada, Ling Kuo, Jennifer Jeanne B. Vicera, Ting Yung Chang, Hoang Quang Minh, Simon Salim, Ting Chung Huang, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Septal ventricular outflow tract ventricular arrhythmias (OT-VAs) are defined as septal origin VAs from the right ventricular or left ventricular OT. Patients with septal OT-VAs may require a sequential bilateral OT ablation. This study aimed to evaluate the electrophysiological characteristics and ablation outcome in patients with septal OT-VAs. Methods: We retrospectively analyzed the electrocardiography and electrophysiological parameters in 96 patients (mean age 49 ± 15 years, 49 male) undergoing bilateral activation mapping before catheter ablation of idiopathic septal OT-VAs. The patients were categorized into three groups based on the successful ablation sites, including the right ventricular outflow tract (RVOT), RVOT/left ventricular outflow tract (LVOT), and LVOT. Results: Mapping in the three groups demonstrated a gradually decreasing and increasing trend in the earliest activation time obtained from the RVOT and LVOT, respectively. The absolute earliest activation time discrepancy (AEAD) of ≤18 milliseconds could predict the requirement for a sequential bilateral ablation with a sensitivity and specificity of 100.0% and 93.7%, respectively. The small AEAD (≤21 milliseconds) was associated with a higher recurrence rate in patients receiving a successful unilateral ablation, while patients with a longer distance between the bilateral OT earliest activation sites (DEA > 26 mm) increased future recurrences after an initially successful sequential bilateral ablation. Conclusions: The application of bilateral OT-VA activation mapping and the measurement of the AEAD and DEA provided not only pivotal information for the ablation strategy, but also prognostic implications for recurrences in patients with septal OT-VAs.

Original languageEnglish
Pages (from-to)298-307
Number of pages10
JournalJournal of cardiovascular electrophysiology
Issue number2
StatePublished - Feb 2018


  • absolute earliest activation time discrepancy
  • catheter ablation
  • distance between bilateral earliest activation sites of outflow tract
  • outflow tract ventricular arrhythmia
  • recurrence


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