Improvement in left ventricular ejection fraction after radiofrequency catheter ablation of premature atrial contractions in a 23-year-old man

Figures

• 

  Figure 1. Echocardiographic data upon presentation to electrophysiology clinic. A: Sample of our patient’s frequent premature atrial contraction (PAC) morphologies (top) and premature ventricular contraction (PVC) morphology (bottom) from ambulatory heart rate monitor. B: The 12-lead electrocardiogram on presentation to clinic on beta-blocker therapy.

• 

  Figure 2. Transthoracic echocardiography before and after ablation. Samples of parasternal long-axis images from transthoracic echocardiography before and after radiofrequency ablation of premature atrial contractions. A: The preablation left ventricle (LV) was dilated, with end-diastolic diameter of 5.9 cm, and demonstrated depressed ejection fraction of 40%. B: After ablation, there was improvement in LV dimensions, with end-diastolic diameter decreasing to 5.2 cm, and LV ejection fraction improved to 50%.

• 

  Figure 3. Intraprocedural surface electrocardiogram and electroanatomic mapping. A: Surface electrocardiogram prior to electroanatomic mapping confirmed P-wave morphology was positive in lead I, biphasic with an initial positive vector in lead V1, and negative in lead III (premature atrial contraction generates the third QRS complex). B: Two sites were ablated (blue arrow and red arrow), viewed from a posterolateral viewpoint (left) and left anterior oblique view (right). Yellow points denote His electrogram positions. Red points and green points denote ablation sites. Unipolar and bipolar electrograms demonstrating points of earliest activation are shown adjacent to their respective ablation sites. The left electrogram corresponds to the ablation target denoted by the blue arrow and the right electrogram corresponds to the ablation target denoted by the red arrow.