Clinical observation of radiofrequency ablation for premature ventricular contractions originating from uncommon His-Purkinje sites

BACKGROUND: Radiofrequency catheter ablation (RFCA) of premature ventricular contractions (PVCs) originating from common locations such as the proximal and middle fascicles of the His-Purkinje system (HPS) has been established as an effective therapy. This report aims to highlight the electrophysiological properties and RFCA of PVCs originating from uncommon locations of the HPS. METHODS: Among 57 patients with fascicular PVCs, 3 with fascicular PVCs originating from uncommon sites were retrospectively analyzed. RESULTS: We identified three patients with PVCs originating separately from diseased fascicles, the dead-end tract (DET), and the distal fascicle. In contrast to PVCs originating from the proximal and medial fascicles, the fascicular potentials could not be recorded at the target sites of patients with PVCs originating from diseased fascicles or the distal fascicle during sinus rhythm. However, these PVCs were successfully ablated from the HPS, guided by recording their earliest fascicular potentials in PVCs. PVCs originating from the DET are morphologically consistent with those originating from the proximal left anterior fascicle or the distal left bundle branch. The corresponding tiny sharp potential of the DET could be mapped, and RFCA of the right coronary cusp achieved successful suppression of PVCs. CONCLUSIONS: The knowledge of the different electrophysiological characteristics of fascicular PVCs originating from uncommon locations can contribute to precise mapping and ablation. For such arrhythmia, the target site for successful ablation should be identified by earliest fascicular potential.