Successful elimination of ventricular arrhythmias by radiofrequency ablation within the left ventricular summit communicating vein using a 5F ablation catheter

Figures

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  Figure 1. A: Twelve-lead electrocardiogram (ECG) recorded during clinical ventricular premature contractions (VPCs). B: Twelve-lead ECG of the pacemap (PM) in the anterior interventricular vein (AIV) (left) and body surface and intracardiac ECG recordings during the VPC demonstrating that the local electrogram preceded the VPC-QRS onset by 35 ms in the AIV (AIV 5-6; right). C: Twelve-lead ECG of the PM at the left coronary cusp (LCC) (left) and body surface and intracardiac ECG recordings during the VPC demonstrating that the local electrogram preceded the VPC-QRS onset by 7 ms at the LCC (ABL1-2; right). D: Twelve-lead ECG of the PM at the aorto-mitral continuity (AMC) (left) and body surface and intracardiac ECG recordings during the VPC demonstrating that the local electrogram preceded the VPC-QRS onset by 15 ms at the AMC (ABL1-2; right). E: Aortography and position of the multielectrode catheters on fluoroscopic images in the left anterior oblique (LAO) (left) and right anterior oblique (right) views. A = atrial electrogram; ABL 1-2 and ABL 3-4 = distal and proximal recordings by the 8F ablation catheter; ABL-uni = unipolar recording by the 8F ablation catheter; H = His-bundle…

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  Figure 2. A: Retrograde coronary sinus venography showing the course of the GCV, AIV, summit-CV, and septal perforator in the LAO (left) and RAO (right) views (Supplemental Video 1). B: Fluoroscopic images showing the position of the tip of the 5F ablation catheter placed at the successful ablation site within the summit-CV in the LAO (left) and RAO (right) views. C: Twelve-lead ECGs of the clinical VPC (left) and PM in the summit-CV (middle) and body surface and intracardiac ECG recordings during the VPC demonstrating that the local electrogram recorded by the ablation catheter within the summit-CV preceded the VPC-QRS onset by 45 ms. D: Activation maps during the VPCs exhibiting the earliest activation within the summit-CV in the anteroposterior (left) and LAO (right) views (Supplemental Video 2). Green tags on the maps represent the PM sites. CS = coronary sinus; LV = left ventricle; SP = septal perforator; summit-CV, LV summit communicating vein; other abbreviations as in Figure 1.

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  Figure 3. Final radiofrequency ablation sites on the VPC activation maps in the anteroposterior (left) and LAO (right) views. Green, orange, light blue, and red tags represent the PM sites, successful ablation site, ablation sites, within the summit-CV, and ablation sites at the AMC and LCC, respectively. Abbreviations as in Figures 1 and 2.