Ultra-High-Density Catheter Ablation of Purkinje Premature Ventricular Contractions Causing Electrical Storm

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  Figure 1. Ablation of Purkinje Premature Ventricular Contractions (A) Emergency coronary angiography reveals acute thrombotic occlusion at the proximal level of the anterior descending artery. (B) 12-Lead electrocardiogram displays sinus rhythm, anterior Q-wave with the persistence of anterior elevation of the ST segment, and bigeminy short-coupled premature ventricular contractions (PVCs) originating in the posterior fascicle. (C) Polymorphic ventricular tachycardia triggered by short-coupled PVC. (D) PVC originating in the posterior fascicle and with a coupling interval of 320 ms. (E) Endocardial bipolar voltage map shows scar tissue in the septal area with areas of low voltage affecting the conduction system and the Purkinje network of the left bundle branch. (F) Activation map, from distal to proximal, demonstrates the Purkinje potential preceding the ventricular PVC with −90 ms precocity.