Bipolar radiofrequency catheter ablation of premature ventricular contractions arising from the left ventricular summit

Bipolar radiofrequency catheter ablation of premature ventricular contractions arising from the left ventricular summitWe present the first case of bipolar catheter ablation (CA) performed in Greece in a 42-year-old male patient who was referred to our hospital due to highly symptomatic premature ventricular contractions (PVCs) originating from the left ventricular (LV) summit following a previous unsuccessful attempt of invasive management.The patient had a history of high (30%) PVC burden associated with LV dysfunction first diagnosed 3 years ago.A transthoracic echocardiogram had shown moderate global LV systolic dysfunction with an estimated ejection fraction of 40%, coronary angiography had ruled out the presence of significant coronary artery disease, and cardiac magnetic resonance imaging had revealed no underlying myocardial fibrosis.The above findings supported the diagnosis of PVC-induced cardiomyopathy. 1 Initially, the patient received a maximally tolerated dose of beta-blocker treatment without a favorable impact on PVC burden.Subsequently, an attempt of CA was performed in another institution.In the first ablation, unipolar radiofrequency lesions were delivered at the junction of the great cardiac vein (GCV) with the anterior interventricular vein (AIV), in the left aortic cusp, the junction of the right and left cups, and the endocardial adjacent areas of the left and right ventricle though without acute procedural success.Upon admission in our hospital, the 12-lead ECG showed sinus rhythm with frequent monomorphic PVCs displaying an RBBB morphology, inferior axis, V2 pattern break, QS in I and aVL, characteristics highly suggestive of an LV summit origin (Figure 1). 2 Following a signed informed consent, a detailed electroanatomical mapping of the coronary venous system (CVS), aortic cusps, the