Safety and efficacy of first‐line cryoablation for para‐hisian ventricular arrhythmias using a cryomapping protocol approach: A case series

Figures

• 

  Figure 1. Protocol of the cryomapping and cryoablation procedures. AV, atrioventricular; VAs, Ventricular arrhythmias

• 

  Figure 2. Case 1: A 72‐year‐old female patient who underwent cryoablation for the first time. A: PVC on body surface ECG. B: Perfect pace mapping at the earliest activation site. C: Earliest ventricular activation site. The red triangle denotes the His bundle potential. A local potential preceded QRS by 30 ms at the distal electrode of the ablation catheter. A local unipolar electrocardiogram shows the QS pattern. D: PVC disappeared 12 s after the start of cryomapping. E: The intracardiac electrocardiogram of final ablation point resulting in successful elimination of PVC. The red triangle denotes the His bundle potential. F: Three‐dimensional (3‐D) mapping and fluoroscopy images taken during cryoablation. The orange arrows denote the atrioventricular block site during cryoablation, and the white arrows denote the site of successful cryoablation. The yellow tag on 3‐D mapping shows the site showing a visible His bundle potential, and the blue tag shows the earliest activation site. PVC, premature ventricular contraction; ECG, electrocardiogram

• 

  Figure 3. Cases 2‐4: Successful elimination of ventricular arrhythmias originating from the para‐Hisian region by first‐line cryoablation. A: PVC on body surface ECG. B: Earliest ventricular activation site on intracardiac electrogram. The red triangles denote the His bundle potential. C: Successful cryoablation sites on 3‐D mapping. The yellow tag shows the site showing a visible His bundle potential, and the blue tag shows the earliest activation site. The white arrow denotes the site of successful cryoablation. PVC, premature ventricular contraction; ECG, electrocardiogram