Ablation of Left Ventricular Summit Premature Ventricular Complexes After Bentall Procedure

Figures

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  Figure 1. Preablation and Postablation Echocardiograms (A to C) Preablation echocardiograms. (D to F) Postablation echocardiograms. Preoperative echocardiogram shows that (A) the aortic valve forward blood flow velocity is 170 cm/s, (B) the area of aortic valve regurgitation is 4.27 cm2, and (C) in the apical 4-chamber view, the LV is 51 mm. Postoperative echocardiogram shows that (D) the aortic valve forward blood flow velocity is 167 cm/s, (E) the area of aortic valve regurgitation is 4.15 cm2, and (F) in the apical 4-chamber view, the LV is 46 mm. LV = left ventricle.

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  Figure 2. PVCs on the 12-Lead ECG PVCs on the 12-lead ECG with an inferior axis, left bundle branch block morphology, a qrS pattern in lead V1, and an abrupt R-wave transition in lead V3. ECG = electrocardiogram; PVC = premature ventricular complex.

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  Figure 3. Preablation and Postablation 12-Lead ECGs Abbreviation as in Figure 2.

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  Figure 4. Earliest Activation Time The earliest activation time was located in the left sinus of the pulmonary artery valve, which was 29 ms preceding the onset of the surface ECG. LAO = left anterior oblique; RAO = right anterior oblique; other abbreviation as in Figure 2.

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  Figure 5. Ablation of the Corresponding Site of the Right Ventricular Outflow Tract Abbreviations as in Figure 4.

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  Figure 6. Earliest Site in the Subaortic Region The earliest site in the subaortic region was identified via the antegrade approach, which was 28 ms preceding the onset of the surface ECG. Radiofrequency ablation at this site completely eliminated the PVCs within 10 seconds. LL = left lateral; PA = pulmonary artery; other abbreviations as in Figures 2 and 4.

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  Figure 7. Fluoroscopic Image of the Ablation Catheter at the Target Site (LAO) Abbreviation as in Figure 4.