Distinct single spiky component of local abnormal ventricular activity and accurate identification of origin of premature ventricular complexes arising from left ventricular summit

Figures

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  Figure 1. A–C: Twelve-lead electrocardiogram (ECG) during sinus rhythm (A), clinical premature ventricular complex (PVC) (B), and electrical bipolar stimulation from the earliest site of distal bipolar microelectrodes (CS 1-2) with excellent match for the QRS complex of clinical PVCs (C). D–F: Surface ECG (I, II, and V1) and intracardiac electrograms during sinus rhythm (D), clinical PVC (E), and electrical stimulation from CS 1-2 (F). Red arrows indicate a single spiky component of local abnormal ventricular activity, late potential during sinus rhythm (D) and prepotential during clinical PVC (E). CS = coronary sinus; HIS = His bundle electrogram; RV = right ventricular apex.

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  Figure 2. A: Fluoroscopic image. B: Impedance-based electroanatomical mapping images. C: Intracardiac electrogram at CS 1-2 and ABL-d. The red arrows show the delayed single spiky component of the local abnormal ventricular activity (LAVA) at CS 1-2 and far-field delayed potential of the LAVA at ABL-d during sinus rhythm, respectively. D: Intracardiac electrogram taken immediately after radiofrequency application. The solid and dotted black rectangles indicate the potential of the distal coronary sinus microelectrodes during sinus rhythm and at the 4 beats after radiofrequency (RF) application, respectively. The solid and dotted red arrows indicate the single spiky component of LAVA and its disappearance at the 4 beats after RF application, respectively. ABL-d = distal site of the ablation catheter; HIS = His bundle electrogram; RAO = right anterior oblique 30° view; RV = right ventricular apex.