Why the study?
The left ventricular summit is a challenging site for percutaneous catheter ablation, and cryoablation may be underutilized when radiofrequency ablation fails.
Does cryoablation via the coronary sinus suppress premature ventricular contractions originating from the left ventricular summit?
Does cryoablation via the coronary sinus suppress premature ventricular contractions originating from the left ventricular summit?
Cryoablation via the coronary sinus may offer a viable and safe approach for left ventricular summit PVCs when radiofrequency ablation fails.
May warrant consideration for RF-refractory LV summit PVCs; hypothesis-generating case report that leaves open need for prospective validation.
The left ventricular summit (LVS) is a challenging location for catheter-based percutaneous ablation due to its anatomical location. There have been case reports of cryoablations performed in this region, but the technique may be underutilized when radiofrequency ablation fails. A 45-year-old male was found to have 25 000 premature ventricular contractions (PVCs) a day despite previous ablation and a reduced ejection fraction of 40% despite medical therapy. Coronary sinus epicardial mapping revealed the coronary sinus distal region generated activations earlier than the QRS onset by 28 ms. Two separate, 4-minute cryoablations were delivered that suppressed the PVCs within 5 seconds. Alternate energy modalities such as cryo may offer a safer and more viable approach for ablation of LVS in select patients.
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Reichert et al. (2020) studied this question.
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