• Takumi Yamada, Naoki Yoshida, Yoshimasa Murakami, Taro Okada, Masahiro Muto, Toyoaki Murohara, Hugh T McElderry, and G Neal Kay.
• Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
• Heart Rhythm. 2008 Feb 1; 5 (2): 184-92.

BackgroundVentricular arrhythmias (VAs) may arise from the aortic sinuses and have electrocardiographic and electrophysiological characteristics that suggest a left (LCC) or right coronary cusp (RCC) origin. However, VAs that arise near the junction of those two cusps (L-RCC) may have unusual features.ObjectivesThe purpose of this study was to examine the electrocardiographic and electrophysiological characteristics of VAs arising from the L-RCC.MethodsWe studied 155 patients with idiopathic VAs with either left or right bundle branch block and an inferior QRS axis morphology and five control subjects undergoing a pacing study.ResultsFor 146 of the 155 patients, the origin determined by the successful ablation site was at the L-RCC in five, LCC in 13, RCC in six, non-coronary cusp in two, right ventricular outflow tract in 108, left ventricular outflow tract in five, left ventricular epicardium in four, and pulmonary artery in three. A qrS pattern in leads V1-V3 was observed only in the VAs with an L-RCC origin. The propagation map revealed that the direction of the propagating wave front from the L-RCC origin produced a vector compatible with a q wave and that the anterior activation to the right ventricular outflow tract via the LCC or RCC formed the r wave. Pacing performed at multiple sites in the aortic root in the control subjects demonstrated that only pacing from the L-RCC could reproduce a qrS pattern in leads V1-V3.ConclusionsThis study revealed that a qrS pattern in leads V1-V3 suggests a site of origin at the L-RCC.

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