Endo-epicardial mapping and radiofrequency catheter ablation of the ventricular arrhythmia of the left ventricle anterobasal zone (summit)

Aim. Ventricular arrhythmias (VA) originating from anterobasal region - left ventricular (LV) (summit) is a challenge for mapping and radiofrequency catheter ablation (RFCA). The study presents the strategy for mapping and RFCA of VA origination from LV summit Methods. Four consecutive patients (3 males, mean age of 66,25±8,75 years old) were underwent for mapping and RFCA of LV summit VA. Results. Left ventricular summit arrhythmias were successfully mapped and eliminated in 4 pts using combined opposite approach from distal great cardiac vein and left coronary cusp or endocardium of anterobasal region opposite of left ventricular summit. In some clinical cases point of effective RFCA of VA didn’t show optimal activation and pace mapping parameters. In spite of different VA morphology in consecutive patients - left bundle branch block (BBB) or right BBB, pseudo delta waves >54 ms, intrinsicoid deflection time >74 ms and maximal deflection index >0,45 indicated left ventricular summit VA. During one-month follow-up patients did not experience VA recurrence. Conclusion. VA arising from left ventricular summit can be effectively cured with RFCA using different approach by opposite ablation technique. Morphology of VA may have left or right BBB in depend on early activation region. Site of VA elimination may not have optimal activation or pace mapping data.