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Ablation of premature ventricular contractions originating from the left ventricular septum

2014; Elsevier BV; Volume: 172; Issue: 1 Linguagem: Inglês

10.1016/j.ijcard.2013.12.043

1874-1754

Zhi‐Qiang Ying, Xingguang Lv, Ji Ma, Jie Wang, Chan Bian,

Atrial Fibrillation Management and Outcomes

A 64-year-old man, with drug-resistant symptomatic premature ventricular contractions (PVCs), was admitted for radiofrequency ablation. His laboratory data were normal, and the presence of structural heart disease was negated by echocardiography. The 12-lead surfaced electrocardiogram revealed normal sinus rhythm with frequent PVCs (Fig. 1, upper panel). The PVCs hand a left axis deviation, R pattern in leads I and aVL, Qr pattern in aVR, QR pattern in lead V1, R pattern in V2–V4, Rs pattern in leads V5–V6, RS pattern in lead II, and rS pattern in leads III and aVF. After obtaining informed consent the electrophysiology study was performed with the patient under local anesthesia. One catheter was inserted via the internal carotid vein into the coronary sinus (CS). At first we perform activation and pace mapping of the right ventricular during the spontaneous PVCs. An endocardial activation preceding the QRS complex of the PVC by 14 ms was observed on the posterior-septal side of the right ventricle. But radiofrequency (RF) application could not eliminate the PVCs at this site. Thus, we suspected the PVCs originated from the left ventricle. We perform activation and pace mapping of the left ventricle and found a point on the posterior-septal side of the left ventricle where the endocardial activation preceded the QRS complex of PVC by 16 ms and the unipolar potential showed a “QS” pattern (Fig. 2). Radiofrequency ablation attempts using irrigated ablation catheter (Navistar Thermocool, Biosense Webster) to this region eliminated the PVCs after 8 s. Thereafter, The PVCs were no longer inducible under an isoproterenol infusion. Postprocedural electrocardiogram showed no residual arrhythmia with a regular sinus rhythm (Fig. 1, lower panel).