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Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics andtreatment by catheter ablation.

Heart Rhythm. 2015 Jan;12(1):67-75..

Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics andtreatment by catheter ablation.

Sadek MM1Benhayon D1Sureddi R1Chik W1Santangeli P1Supple GE1Hutchinson MD1Bala R1Carballeira L1Zado ES1Patel VV1Callans DJ1,Marchlinski FE1Garcia FC2.


The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF).


The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT.


In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed.


Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications.


VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation.Catheter ablation can be safely performed and is facilitated by ICE imaging.



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Dr Anil Saxena
Director, Cardiac Pacing & Electrophysiology
Fortis Escorts Heart Institute
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Secretary, Indian Heart Rhythm Society
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