Highlights the diagnostic utility of epicardial mapping via cardiac veins for identifying intramural ventricular septal PVC origins, though ablation may be limited by anatomical accessibility.
May facilitate localization of intramural septal PVCs via venous mapping; leaves open ablation feasibility in inaccessible sites.
A 68-year-old man with symptomatic idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Radiofrequency catheter ablation was unsuccessful at the earliest endocardial ventricular activation site in the left coronary cusp. Epicardial mapping via the cardiac veins was then performed. Balloon-occluded coronary sinus venography revealed the small branches of the anterior interventricular vein. Mapping with a microcatheter revealed the earliest ventricular activation and perfect pace map at the distal portion of the septal perforating branch, suggesting an intramural ventricular septal PVC origin. Catheter ablation was abandoned because of the inaccessibility of the ablation catheter to that site via the venous system.
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Yamada et al. (2009) studied this question.
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