Patients with acute onset of periaortic VTs
Three (2.8%) patients had episodes of sustained or incessant NSVT
originating from OT (OTVT) that was detected using 12-lead ECG (Figure
1A/B/C). Additionally, one other patient (0.9%) had sustained episodes
of VT originating from the lateral portion of the LV, and two other
patients (1.8%) had sustained VTs of unknown origin. The clinical
characteristics of the three patients with OTVTs are summarized in Table
2. All patients developed acute onset of chest discomfort related to the
sustained or incessant NSVTs and were transported to the emergency
department. Coronary angiography was performed to confirm that none of
them had a worsening case of ischemic heart disease. Based on their
clinical courses and 12-lead ECGs, they were diagnosed with periaortic
VTs. The average duration between AVR and onset of periaortic VTs was
12.3±6.7 years. Morphologically, all VTs had an inferior axis, and two
patients and one patient, respectively, had right- and left-bundle
branch block patterns. One VT patient with right-bundle branch block
pattern had polymorphic configuration (Figure 1A/B/C). The mean cycle
length of VTs was 310±36.1 msec.
Among 109 patients after SAVR, four (3.7%) without documented
periaortic VTs were transported to the emergency department with sudden
cardiopulmonary arrest (all patients with asystole on arrival). Six
(5.5%) had definite cardiac death related to worsening of congestive
heart failure or ischemic attack, 18 (16.5%) had non-cardiac death
related to underlying diseases. Another 6 (5.5%) died from unknown
causes in the follow-up periods.