Correlative Anatomy for the Invasive Electrophysiologist: Outflow Tract and Supravalvar Arrhythmia

Authors

  • SAMUEL J. ASIRVATHAM M.D.

    1. Division of Cardiovascular Diseases, Department of Internal Medicine; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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  • Editor: Stephen C. Hammill, M.D.

Address for correspondence: Samuel J. Asirvatham, M.D., Division of Cardiovascular Diseases and Internal Medicine, and Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. Fax: 507-255-2550; E-mail: asirvatham.samuel@mayo.edu

Abstract

Radiofrequency ablation in the outflow tract and great arteries is increasingly performed to treat a variety of symptomatic cardiac arrhythmias. The regional anatomy of these structures is among the most complex of those encountered by cardiac electrophysiologists. An exact appreciation of the relationships between these overlapping structures and their proximity to the coronary arterial and conduction system is essential for rational, safe, and effective ablation for these arrhythmias. A supravalvar portion of the aorta is a unique site for arrhythmia origin where the arrhythmogenic substrate for atrial arrhythmias, ventricular arrhythmias, and accessory pathways may all be located. Discussed in this review are the main principles of outflow tract and supravalvar arrhythmia, and these are correlated with fluoroscopy, electrograms, and electrocardiography that help guide the invasive electrophysiologist.

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