Mechanical suppression of premature ventricular complexes during catheter ablation procedures

Figures

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  Fig. 1A. Twelve lead electrocardiogram showing left bundle branch block, inferior axis PVC in a bigeminal pattern.

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  Fig. 1B. Fig. 1 B: Site just below pulmonary valve at septal RVOT had electrograms preceding PVC QRS by 22 ms.

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  Fig. 1C. In pulmonary artery the site of earliest activation had electrograms preceding PVC QRS by 35 ms. CARTO Map showing the location of the ablation catheter. (Adapted with permission from Springer Nature: Springer, Cham [Cardiac Electrophysiology by Natale A., Wang P., Al-Ahmad A., Estes N. [copyright] (2020) [21]

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  Fig. 1D. Pace mapping at the site of earliest activation in PA had 95% pace match. (Adapted with permission from Springer Nature: Springer, Cham [Cardiac Electrophysiology by Natale A., Wang P., Al-Ahmad A., Estes N. [copyright] (2020) [21]

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  Fig. 1E. Pressure from ablation catheter at the site of earliest activation in pulmonary artery resulted in complete suppression of PVCs. The catheter was pulled back from the site with return of the PVCs. (Adapted with permission from Springer Nature: Springer, Cham [Cardiac Electrophysiology by Natale A., Wang P., Al-Ahmad A., Estes N. [copyright] (2020) [21]

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  Fig. 2. A: Figure shows at the site with earliest electrograms, pressure with ablation catheter resulted in suppression of PVCs. This site was located in middle cardiac vein. B: Left anterior oblique fluoroscopic vein; ablation catheter is in the middle cardiac vein. It can also be appreciated a JR5 catheter is in the right coronary artery and right coronary angiogram is done.

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  Fig. 3. 3A: Shows mechanical suppression of PVC at the site with earliest electrograms. Radiofrequency energy was given at the same site. 3B: Application of radiofrequency application at this site resulted in flurry of PVCs. Fig. 3C: Right anterior oblique fluoroscopic view of left coronary angiogram showing the relationship of the ablation catheter to the left coronary system. The position of the ablation catheter is where suppression of PVCs was seen. Fig. 3D Left anterior oblique fluoroscopic view of left coronary angiogram.