Successful ethanol injection into the anterior interventricular cardiac vein for ventricular premature contractions arising from the left ventricular summit

Figures

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  Figure 1. Twelve-lead electrocardiogram (A), intracardiac electrograms obtained by a duodecapolar electrode catheter inserted into the anterior interventricular cardiac vein (AIV) (B), and the catheter position with a contrast injection into the left coronary cusp (C). The earliest activation (indicated at AIV7-8) without a pre-potential precedes the QRS onset by 52 ms in the proximal AIV (arrow). The arrowheads indicate the first septal branch. CS = coronary sinus; LAO = left anterior oblique; RAO = right anterior oblique.

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  Figure 2. Representative transient successful radiofrequency (RF) application and catheter positions (A–D). Note that the ventricular arrhythmias were eliminated after starting the RF application (B), but a drastic impedance change precluded a continuous energy delivery for only 13.5 s (B, D). We could not perform another RF delivery at the same site because of a higher impedance (>250 Ω), and the ventricular premature contractions soon reappeared (not shown). The order of the electrograms in panel B is the same as that in panel A. ABd, ABp, and uni indicate the distal, proximal, and unipolar electrograms of the ablation catheter, respectively. Other abbreviations as in Figure 1.

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  Figure 3. Procedural series of the ethanol injections into the anterior interventricular cardiac vein (AIV). A: Cannulation of an angioplasty wire and balloon (white arrowhead) into the AIV close to the culprit site. B: An ethanol infusion of 2 mL following a contrast medium injection through a wire lumen. The area surrounded by the dotted lines indicates the area stained by the contrast medium injection. C: Left coronary angiography following the ethanol injection into the AIV (EIAIV). The contrast stain (dotted line) lies close to the left anterior descending artery between the distal left main trunk and first septal branch (black arrowheads). D: Electrocardiogram tracing during the EIAIV. Frequent ventricular premature contractions reappeared constantly before the injection (upper), which disappeared soon after a test injection of a small amount of contrast medium (lower, arrow). LAO = left anterior oblique; RAO = right anterior oblique.