Background The superior para-septal region (SPSR), an intricate anatomical structure involving the tricuspid valve and the outflow tracts, can be a rare source for idiopathic ventricular tachycardia arrhythmias (VAs). However, VAs originating from this region have yet to be thoroughly elucidated. The study aims to evaluate the electrocardiographic (ECG) and electrophysiological characteristics of patients undergoing idiopathic SPSR-VAs. Methods From January 2021 to September 2023, a rigorous screening of 684 patients undergoing radiofrequency (RF) catheter ablation for idiopathic VAs was undertaken at Fuwai Central China Cardiovascular Hospital. Those with the earliest site of VAs pinpointed to the SPSR, via activation mapping, were enrolled. The comprehensive ECG analyses and electrophysiological traits were characterized according to the varied SPSR locations. All acute procedural complications and delayed adverse events associated with ablation were meticulously documented. Lastly, a rigorous long-term follow-up was instituted. Results Twelve (1.8%) patients (mean age 53.3 ± 18.9 years, 16.7% female) with idiopathic SPSR-VAs were included, with a mean PVC burden of 19.3 ± 6.6%. Two patients had previous ablations. All PVCs featured inferior axis, LBBB morphology, and early precordial transition (< V3). Notably, 66.7% displayed a positive dominant avL wave (notched rsrsr’ or rR’), while 33.3% had a negative dominant pattern (rSr’). A total of 20 RF applications were executed in 12 patients. Among them, 6 (50%) patients achieved VAs elimination via single-site ablation, whereas 50% required a sequential RF ablation approach in both right and left side of SPSR. At last, a remarkable acute success rate of 100% was achieved for ablation in 12 patients. Junctional beats occurred in two cases during RF but resolved post-ablation. Over 12.1 ± 2.3 months of follow-up, no atrio-ventricular block was reported, and VAs recurrence was observed in two (16.7%) patients. Conclusions Mapping and ablation of SPSR-VAs is challenging, yet the distinct differences in avL provide crucial guidance. Achieving acute arrhythmia elimination in 50% of patients necessitates a sequential ablation approach targeting both sides of the SPSR. Graphical Abstract

Idiopathic ventricular arrhythmias arising from the superior para-septal region

期刊论文
发表日期：

2026年2月17日

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Ji-Fang Ma,
You Zhou,
Hai-Xia Fu

摘要

Background

The superior para-septal region (SPSR), an intricate anatomical structure involving the tricuspid valve and the outflow tracts, can be a rare source for idiopathic ventricular tachycardia arrhythmias (VAs). However, VAs originating from this region have yet to be thoroughly elucidated. The study aims to evaluate the electrocardiographic (ECG) and electrophysiological characteristics of patients undergoing idiopathic SPSR-VAs.

Methods

From January 2021 to September 2023, a rigorous screening of 684 patients undergoing radiofrequency (RF) catheter ablation for idiopathic VAs was undertaken at Fuwai Central China Cardiovascular Hospital. Those with the earliest site of VAs pinpointed to the SPSR, via activation mapping, were enrolled. The comprehensive ECG analyses and electrophysiological traits were characterized according to the varied SPSR locations. All acute procedural complications and delayed adverse events associated with ablation were meticulously documented. Lastly, a rigorous long-term follow-up was instituted.

Results

Twelve (1.8%) patients (mean age 53.3 ± 18.9 years, 16.7% female) with idiopathic SPSR-VAs were included, with a mean PVC burden of 19.3 ± 6.6%. Two patients had previous ablations. All PVCs featured inferior axis, LBBB morphology, and early precordial transition (< V3). Notably, 66.7% displayed a positive dominant avL wave (notched rsrsr’ or rR’), while 33.3% had a negative dominant pattern (rSr’). A total of 20 RF applications were executed in 12 patients. Among them, 6 (50%) patients achieved VAs elimination via single-site ablation, whereas 50% required a sequential RF ablation approach in both right and left side of SPSR. At last, a remarkable acute success rate of 100% was achieved for ablation in 12 patients. Junctional beats occurred in two cases during RF but resolved post-ablation. Over 12.1 ± 2.3 months of follow-up, no atrio-ventricular block was reported, and VAs recurrence was observed in two (16.7%) patients.

Conclusions

Mapping and ablation of SPSR-VAs is challenging, yet the distinct differences in avL provide crucial guidance. Achieving acute arrhythmia elimination in 50% of patients necessitates a sequential ablation approach targeting both sides of the SPSR.

Graphical Abstract