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<journal-meta>
<journal-id journal-id-type="publisher-id">CC</journal-id>
<journal-id journal-id-type="nlm-ta">Cardiol Croat</journal-id>
<journal-title-group>
<journal-title>Cardiologia Croatica</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Cardiol. Croat.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">1848-543X</issn>
<issn pub-type="epub">1848-5448</issn>
<publisher><publisher-name>Croatian Cardiac Society</publisher-name></publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">CC 2021 16_9-10_312</article-id>
<article-id pub-id-type="doi">10.15836/ccar2021.312</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Arrhythmias in valvular heart disease</subject></subj-group>
<subj-group subj-group-type="subheading"><subject>Extended Abstract</subject></subj-group>
</article-categories>
<title-group>
<article-title>Ventricular arrhythmias arising from valvular structures &#x2013; a look at the valve disease through an ECG</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2852-3730</contrib-id><name><surname>Markovi&#x0107;</surname><given-names>Matija</given-names></name><xref ref-type="corresp" rid="cor1">*</xref></contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2592-8302</contrib-id><name><surname>Premu&#x017E;i&#x0107; Me&#x0161;trovi&#x0107;</surname><given-names>Ivica</given-names></name></contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1229-7983</contrib-id><name><surname>Letilovi&#x0107;</surname><given-names>Tomislav</given-names></name></contrib>
<aff id="aff1"><institution>University Hospital &#x201E;Merkur&#x201C;</institution>, <addr-line>Zagreb</addr-line>, <country country="hr">Croatia</country></aff>
</contrib-group>
<author-notes>
<corresp id="cor1"><label>*</label>Address for correspondence: Matija Markovi&#x0107;, Klini&#x010D;ka bolnica Merkur, Zaj&#x010D;eva 19, &#x2028;HR-10000 Zagreb, Croatia./ Phone: +385-1-2253-205 / E-mail: <email xlink:href="matija.markovic@kb-merkur.hr">matija.markovic@kb-merkur.hr</email></corresp></author-notes>
<pub-date pub-type="epub-ppub"><month>09</month><year>2021</year></pub-date>
<volume>16</volume>
<issue>9-10</issue>
<fpage>312</fpage>
<lpage>312</lpage>
<history>
<date date-type="received"><day>01</day><month>08</month><year>2021</year></date>
<date date-type="accepted"><day>05</day><month>08</month><year>2021</year></date>
</history>
<permissions>
<copyright-year>2021</copyright-year>
<copyright-holder>Croatian Cardiac Society</copyright-holder>
</permissions>
<kwd-group kwd-group-type="author"><title>KEYWORDS: </title><kwd>premature ventricular complexes</kwd><kwd>ventricular arrhythmias</kwd><kwd>outflow tract</kwd><kwd>catheter ablation</kwd></kwd-group>
</article-meta>
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<p>Cardiologists are familiar with valvular heart diseases but often they do not perceive heart valves as source of ventricular arrhythmias (VA). In patients with structural heart disease (SHD) VAs originate from a substrate in diseased myocardium, while in patients without SHD most common origins are outflow tracts (OT) (<xref ref-type="bibr" rid="r1"><italic>1</italic></xref>). Premature ventricular complexes (PVC) from OT are either from subvalvular, valvular or supravalvular myocardium as there are myocardial extensions above the semilunar valves, these VAs are created predominantly by mechanism of triggered activity or enhanced automaticity (<xref ref-type="bibr" rid="r1"><italic>1</italic></xref>, <xref ref-type="bibr" rid="r2"><italic>2</italic></xref>). Papillary muscles, mitral and tricuspid anulus, aortomitral continuity and other sites in a structurally normal heart can also be the origin VAs. There are general and specific ECG characteristics that can localize the origin of VAs: bundle branch block type, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth, therefore mapping of the PVC starts in the region that is presumed by ECG characteristic (<xref ref-type="bibr" rid="r3"><italic>3</italic></xref>). While different anti-arrhythmic drugs (AAD) aim at different mechanisms; calcium channel blocker can suppress triggered activity and beta-clocker can suppress automaticity, in general ablation is more effective in clinically meaningful reduction of PVCs compared to AAD (up to 95% vs. up to 25%) (<xref ref-type="bibr" rid="r4"><italic>4</italic></xref>). Ablations are generally safe but complication rates of catheter ablation in aortic root are not negligible and include myocardial rupture and tamponade, stroke, valvular damage, and coronary artery occlusion; these complications can be lowered by usage of intracardiac ultrasound (ICE) (<xref ref-type="bibr" rid="r1"><italic>1</italic></xref>, <xref ref-type="bibr" rid="r4"><italic>4</italic></xref>). When mapping arrhythmias from the valves, we should stop perceiving the heart structures or valves as isolated parts and acknowledge that regional anatomy of these structures is among the most complex of those encountered by cardiac electrophysiologists, e.g., aortic valve is directly related with both atria, the interatrial septum, the right ventricular outflow tract and pulmonary valve, and the aortomitral continuity. Ablation is highly effective in suppression of PVCs, it has low numbers of complications, but ablation in aortic region brings serious complications to the table, therefore shared decision making with the patient and usage of ICE is of upmost importance.</p>
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<ref-list>
<title>LITERATURE</title>
<ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cronin</surname><given-names>EM</given-names></name><name><surname>Bogun</surname><given-names>FM</given-names></name><name><surname>Maury</surname><given-names>P</given-names></name><name><surname>Peichl</surname><given-names>P</given-names></name><name><surname>Chen</surname><given-names>M</given-names></name><name><surname>Namboodiri</surname><given-names>N</given-names></name><etal/><collab>ESC Scientific Document Group</collab></person-group>. <article-title>2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias.</article-title> <source>Europace</source>. <year>2019</year> August 1;<volume>21</volume>(<issue>8</issue>):<fpage>1143</fpage>&#x2013;<lpage>4</lpage>. <pub-id pub-id-type="doi">10.1093/europace/euz132</pub-id><pub-id pub-id-type="pmid">31075787</pub-id></mixed-citation></ref>
<ref id="r2"><label>2</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gami</surname><given-names>AS</given-names></name><name><surname>Noheria</surname><given-names>A</given-names></name><name><surname>Lachman</surname><given-names>N</given-names></name><name><surname>Edwards</surname><given-names>WD</given-names></name><name><surname>Friedman</surname><given-names>PA</given-names></name><name><surname>Talreja</surname><given-names>D</given-names></name><etal/></person-group> <article-title>Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts.</article-title> <source>J Interv Card Electrophysiol</source>. <year>2011</year> January;<volume>30</volume>(<issue>1</issue>):<fpage>5</fpage>&#x2013;<lpage>15</lpage>. <pub-id pub-id-type="doi">10.1007/s10840-010-9523-3</pub-id><pub-id pub-id-type="pmid">21161573</pub-id></mixed-citation></ref>
<ref id="r3"><label>3</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yamada</surname><given-names>T</given-names></name></person-group>. <article-title>Twelve-lead electrocardiographic localization of idiopathic premature ventricular contraction origins.</article-title> <source>J Cardiovasc Electrophysiol</source>. <year>2019</year> November;<volume>30</volume>(<issue>11</issue>):<fpage>2603</fpage>&#x2013;<lpage>17</lpage>. <pub-id pub-id-type="doi">10.1111/jce.14152</pub-id><pub-id pub-id-type="pmid">31502322</pub-id></mixed-citation></ref>
<ref id="r4"><label>4</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marcus</surname><given-names>GM</given-names></name></person-group>. <article-title>Evaluation and Management of Premature Ventricular Complexes.</article-title> <source>Circulation</source>. <year>2020</year> April 28;<volume>141</volume>(<issue>17</issue>):<fpage>1404</fpage>&#x2013;<lpage>18</lpage>. <pub-id pub-id-type="doi">10.1161/CIRCULATIONAHA.119.042434</pub-id><pub-id pub-id-type="pmid">32339046</pub-id></mixed-citation></ref>
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