A single origin in the left ventricular ostium can have two breakout sites, resulting in a couplet of PVCs with different morphologies that can be successfully ablated at a single site.
Single-site RCC ablation may eliminate dual-morphology PVC couplets; leaves open prevalence and reproducibility of dual breakout sites.
A 59-year-old man with two different premature ventricular contractions (PVCs) forming a couplet underwent electrophysiological testing. Although pacing from the aorto-mitral continuity (AMC) produced an excellent pace map of one type of PVCs, a radiofrequency application within the right coronary cusp (RCC) eliminated all the PVCs. This case demonstrates that a single origin with two breakout sites in the left ventricular ostium (LVos) may result in a couplet consisting of different PVCs and preferential conduction from the RCC to AMC may also occur. These possibilities should be kept in our mind when predicting sites of origin of LVos ventricular arrhythmias.
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Yamada et al. (2010) studied this question.
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