Intramural Left Ventricular Posterior Superior Process Premature Ventricular Complex Ablation with Intracardiac Echocardiography

Figures

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  Fig. 1. A. Left superior axis deviation with ‘reversed V2 lead pattern break’ and LBBB morphology in Lead V1 and short QRS duration of 86 ms. B. ICE imaging during targeted radiofrequency ablation within all three adjacent cardiac chambers (RA, RV, and LV). C. Cardiac MRI with late gadolinium enhancement demonstrating myocardial fibrosis at the basal LV inferolateral region.

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  Fig. 2. A. Electrogram signal at coronary sinus (CS); middle cardiac vein (MCV) ostium early by [-13 ms (milliseconds)] but appeared to be far field. B. Electrogram signal inside middle cardiac vein but local ventricular electrogram signal is late. C. Basal left ventricular septum prepotential electrogram signal was early by (−11 ms). D. The earliest prepotential electrogram signal was recorded at the basal right ventricular septum (−18 ms).

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  Fig. 3. A. Local activation time (LAT) map of PSP-LV. B. Incessant PVCs were observed during basal right ventricle (RV) septal ablation. C. Catheter ablation of the basal inferoseptal process of the left ventricle resulted in permanent suppression of PVCs after 14.6 seconds. D. Complete suppression of PVCs achieved using an approach targeting three adjacent locations during ablation.

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  Fig. 4. Intracardiac echocardiography demonstrating adjacent anatomical barriers and an area of hyperechogenicity at the ablation lesion site in the basal left ventricle.