Demonstrates that PVCs mapped to the great cardiac vein may have an intramural rather than epicardial origin and can be successfully eliminated with radiofrequency ablation.
May inform mapping of refractory PVCs to the GCV; hypothesis-generating and requires prospective validation before practice change.
A 37-year-old woman with idiopathic premature ventricular contractions (PVCs), exhibiting a right bundle branch block and inferior axis QRS morphology, underwent electrophysiological testing. The earliest ventricular activation with an isolated prepotential was observed within the great cardiac vein during the PVCs. Pacing from this site with an output of 10 mA produced an excellent pace map, whereas that with an output of 2 mA produced a wider QRS with notches in the early phase. A radiofrequency application delivered at this site eliminated the PVCs. These findings suggested that the PVC origin might have been intramural rather than epicardial.
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Yamada et al. (2010) studied this question.
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