Ventricular tachycardia originating from the aortic sinus cusp in patients with idiopathic dilated cardiomyopathy

BACKGROUND Ventricular tachycardia (VT) in patients with idiopathic dilated cardiomyopathy often originates from the basal left ventricular myocardium and also can originate from the conduction system. The basal left ventricular myocardium reaches to the base of the aortic sinus cusps. OBJECTIVE The purpose of this study was to assess the prevalence of VT originating from the aortic sinus cusps in patients with idiopathic dilated cardiomyopathy. METHODS Thirty-three consecutive patients with nonischemic cardiomyopathy (24 men, age: 59 +/- 11 years, ejection fraction: 29% +/- 14%) were referred for ablation. RESULTS VTs originating from the aortic sinus cusps were identified in 8 of 33 patients (24%). The presence of low voltage in the basal left ventricle correlated with the inducibility of aortic sinus cusp VTs. All but 1 aortic sinus cusp VTs were effectively ablated. In 1 patient, the site of origin of the VT was <10 mm from the ostium of the left main coronary artery and ablation was not attempted. CONCLUSION In patients with idiopathic dilated cardiomyopathy, VT often originates from the aortic sinus cusps. The large majority of these VTs can be successfully ablated.