rv-lv and epicardial anatomy in vt … · inlet-outlet ring around right av junction and outflow...

©2012 MFMER | 3200268v1(2003)-1

Samuel J. Asirvatham, M.D.Mayo Clinic – Rochester

AF, VT, VF Summit – Chicago, IllinoisFriday, December 6, 2019: 7:50 to 8:15 a.m.

RV-LV and Epicardial Anatomy in VT

Right Ventricular Outflow Tract VT

26 yrs female, 25,000 PVCs on Holter 3 failed ablations

LAO

Cardiac Vein

RVOT

LVOT

retrograde

approachLCX

LAD

Normal HeartDirection of Great Arteries

Anterior View

RV

LV

Ao PA

• Pulmonary artery

Anterior to aorta

To left shoulder

• Ascending aorta

Posterior to PA

To right shoulder

• Aorta-PA angle

60 to 90 degrees

Normal HeartVentricles

Long-Axis View

RVOT

LV

Ao

LA

Normal HeartValves & Coronary Arteries

Cardiac Base

MVTV

PV

AVLCX

LADRCA

CS

Conus

Inlet-outlet ring aroundRight AV junction and Outflow tracts

Left AV junction

Trabecular componentof right ventricle

Left ventricle

Ventricular bundle branches on apical trabecular septum

Primaryseptum

Dead-end tract

AV grove

Rightventricle

AV grove

Compact node

Penetrating bundle

Dead-end tract

Branching bundle and bundle branchesCP1041447-5

12-lead ECG

RVOT Anatomy LPO

Lasso in

aortic-root

I

V1

V2

Lasso at Aortic Sinus of Valsava

Normal HeartExternal Topography

Superior View

RAA

LAA

©2012 MFMER | 3200268v1(2003)-27

©2012 MFMER | 3200268v1(2003)-28

Normal HeartTransverse Sinus

Anterior View Left Lateral View

Ao

PA

PA

Ao

LA

Normal HeartPericardium

Opened Parietal Pericardium

Internal Cardiac AnatomyAtrioventricular Valves

Tricuspid Valve (RV View)

S

A

P

©2012 MFMER | 3208966-38

Internal Cardiac AnatomyVentricles

Right Ventricle (Wall Removed, Ant View)

PB

SB

IS

MB

©2012 MFMER | 3208966-40

Internal Cardiac AnatomyAtrioventricular Valves

Mitral Valve (Opened, LA Aspect)

Anterior

Posterior

ALPM

LA

LV

©2012 MFMER | 3208966-41Abou Ezzeddine, et al. JCE, 2010

Moderator band VT

©2012 MFMER | 3208966-43

©2012 MFMER | 3200268v1(2003)-45

Samuel J. Asirvatham, M.D.Mayo Clinic – Rochester

AF, VT, VF Summit – Chicago, IllinoisFriday, December 6, 2019: 7:50 to 8:15 a.m.

RV-LV and Epicardial Anatomy in VT