Key result
Catheter ablation positioned under the septal leaflet of the tricuspid valve resulted in complete elimination of drug-refractory ventricular premature beats while protecting the AV node.
Case Report (n=1)
Positioning the ablation catheter under the septal leaflet of the tricuspid valve is a novel technique that provides a stable position and protects the AV node during ablation of VPBs near the His bundle.
May support safe para-Hisian ablation for refractory VPBs; hypothesis-generating and requires prospective validation.
A 59-year-old female with frequent, drug-refractory ventricular premature beats (VPBs) was referred for catheter ablation. On her resting ECG, monomorphic VPBs were present in bigeminic pattern with axis similar to sinus rhythm, transition zone in lead V3 and slurring in lead III, V2, and V3 (Panel A). During the procedure, the earliest ventricular activation site was localized just below the His bundle and preceded the onset of the QRS by 36 ms. To avoid damage to the AV node, the ablation catheter was manoeuvred with the support of a steerable sheath (Agilis, St Jude Medical) under the septal leaflet of the tricuspid valve with navigation by fluoroscopy (Panel B) and intracardiac echocardiography. Radiofrequency ablation (25 W, 60 s) at the site of earliest activation resulted in complete elimination of the VPBs. This case report describes a novel technique of catheter ablation of VPBs in the vicinity of the His bundle. Positioning the ablation catheter under the septal leaflet of the tricuspid valve led both to a stable position and provided protection of the AV node during radiofrequency energy delivery by the tricuspid anulus. The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E%E2%80%93learning/Clinical-cases/Electrophysiology/EP-Case-Reports.
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Clemens et al. (2015) conducted a case report in frequent, drug-refractory ventricular premature beats (n=1). Catheter ablation under the septal leaflet of the tricuspid valve was evaluated on elimination of ventricular premature beats. Catheter ablation positioned under the septal leaflet of the tricuspid valve resulted in complete elimination of drug-refractory ventricular premature beats while protecting the AV node.
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