Adjuvant use of a cryoballoon to facilitate ablation of premature ventricular contraction–triggered ventricular fibrillation originating from the moderator band

Figures

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  Figure 1. A: Electrocardiogram on presentation with sinus rhythm and frequent monomorphic premature ventricular contractions (PVCs). B: Frequent short-coupled monomorphic PVCs. C: Ventricular fibrillation initiated by a PVC.

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  Figure 2. Electroanatomic map of the right ventricle. Endocardial structures were identified on intracardiac echocardiography and incorporated into the map: the blue semitransparent structure represents the moderator band and the solid gray structure the anterior papillary muscle. Ablation markers (red and pink dots) are indicated across the length of the moderator band as well as on the anterior papillary muscle. The yellow circles indicate the region of the His bundle.

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  Figure 3. A: The inflated cryoballoon visualized within the right ventricle and apposed to the moderator band visualized on intracardiac echocardiography. The position of the ultrasound beam depicted within the electroanatomic map is shown in the top right corner. B: Diagram illustrating the structures identified in A. ICD = implantable cardioverter-defibrillator.

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  Supplemental Figure 1. (A) Pace-mapping from the lateral aspect of the moderator band demonstrating match between the clinical PVC (left) and the paced QRS morphology (center); the location of pacing is shown on the electroanatomic map (right). (B) Variation in elicited QRS morphology with pacing at this site.