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.