Anatomical vs. electrophysiological approach for ablation of premature ventricular contractions originating from the left ventricular summit (ISESHIMA-SUMMIT Study)

Figures

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  Figure 1. The tagging method of the EAS in the epicardium and LMT using the CARTO system. (A) Local electrograms recorded at the epi-EAS, endo-EAS, and ECS. The solid line represents the activation of the local electrogram, and the dotted line indicates the onset of the surface QRS. (B) After completing the endocardial activation mapping, the position of the multielectrode wire catheter can be displayed on the CARTO 3 system. A pink tag is also placed on the ostium of the LMT. The white arrow indicates the epi-EAS location seen in AIV5-6. (C) The green tag indicates the epi-EAS placed on the CARTO system, utilizing a sound-based geometry, where the fan of the CARTOSOUND is used to traverse the long axis of the wire catheter. (D) The orange tag is the ECS of the endocardial site closest to the tagged epi-EAS. The blue tag is the endo-EAS. Abbreviations: ABL, ablation catheter; AIV, anterior interventricular vein; aVF, augmented vector foot; aVL, augmented vector left; aVR, augmented vector rihgt; ECS, endocardial closest site; endo-EAS, endocardial earliest activation site; epi-EAS, epicardial earliest activation site; LCC, left coronary cusp; LMT, left main coronary trunk; LV, left…

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  Figure 2. The flow chart of the mapping and ablation procedure. The ablation sites are depicted with consistent colour coding for each tag as used in Figure 1. Abbreviations: ECS, endocardial closest site; endo-EAS, endocardial earliest activation site; epi-EAS, epicardial earliest activation site; LV, left ventricle; RF, radiofrequency; VAs, ventricular arrhythmias.

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  Figure 3. Receiver operating characteristic curves predicting (A) successful ablation in the ECS and (B) successful ablation in the endo-EAS. Abbreviations: AUC, area under the curve; LMT, left main coronary trunk; the others are as shown in Figure 2.

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  Figure 4. The flow chart of the recommended endocardial ablation strategies for VAs originating from the LVS. Abbreviations: CVS, coronary venous system; the others are as shown in Figure 3.