Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction

Figures

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  Figure 1. Baseline 12-lead electrocardiogram demonstrating ventricular bigeminy. The QRS morphology shows a right bundle branch block pattern with right inferior axis, suggesting most likely a left ventricular outflow tract origin.

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  Figure 2. Activation map showing earliest sites of activation on right ventricular outflow tract (20–24 ms ahead of QRS, far-field), left ventricular outflow tract (on time with QRS), and epicardium (26 ms ahead of QRS, far-field).

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  Figure 3. Bipolar ablation. A: Two ablation catheters (Abl1 or active and Abl2 or ground) are positioned in opposite sides of the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT), respectively, with a distance of 20 mm separating them. The active and ground catheters were alternated by switching the connections. B: Position of the catheters on right anterior oblique (RAO) and left anterior oblique (LAO) fluoroscopic views; a decapolar catheter is placed inside the coronary sinus with the distal tip at the level of the great cardiac vein–anterior interventricular vein junction. C: Final lesions delivered from the RVOT and LVOT to achieve premature ventricular contraction elimination. D: Intracardiac echocardiography views of the RVOT/LVOT obtained with the probe positioned at the base of the right ventricle followed by clockwise rotation; the catheter tip position can be discerned by the acoustic shadows; note increased echogenicity of the septum after initial lesions.