Key result
Reversed U-curve ablation targeting local potentials successfully eliminates unmappable RVOT ventricular parasystole.
Why the study?
Ablation of fusion QRS complexes caused by ventricular parasystole is rarely reported and presents unexpected difficulties due to interference with conventional mapping techniques.
Case Report (n=1)
The reversed U curve method and identification of special local potentials can guide successful ablation of ventricular parasystole when fusion QRS complexes interfere with conventional mapping.
May support ablation of fusion QRS in symptomatic RVOT parasystole; hypothesis-generating for targeting parasystolic foci.
BACKGROUND: When the coupling interval is matched, ventricular parasystole can form a stable fusion QRS complex with sinus rhythm. Ablation of a fusion QRS complex has been rarely reported and is unexpectedly difficult. CASE PRESENTATION: We describe a case of ventricular parasystole from muscle sleeves of the right ventricular outflow tract. The patient was a 54-year-old woman who was admitted to the hospital because of frequent palpitations for 3 months. Anti-arrhythmic drugs had been ineffective, and she had no history of cardiovascular disease. Because the fusion QRS complex interfered with the conventional mapping technique, we could not eliminate the ventricular parasystole successfully. RESULTS AND CONCLUSIONS: Finally, we used the reversed U curve method and found that the source of ventricular arrhythmia was in the right cusp according to the special local potential. A fusion QRS complex formed by ventricular parasystole and nodal ventricular activation make mapping and ablation difficult. The special local potential was the only evidence available to confirm the target of ablation satisfactorily.
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Wang et al. (2019) conducted a case report in Ventricular parasystole originating from the right ventricular outflow tract (n=1). Ablation using the reversed U curve method was evaluated on Successful ablation of ventricular parasystole. Ablation of unmappable ventricular parasystole from the right ventricular outflow tract was successfully achieved using the reversed U curve method guided by special local potentials.
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