Successful catheter ablation of para-Hisian premature ventricular complex

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Beca de la Asociación del Ritmo Cardiaco para Formación en Investigación Post-Residencia en centros españoles. Background To predict the premature ventricular complex (PVC) site of origin (SOO) before the ablation procedure has important implications. 12 lead ECG information as well clinical characteristics are related with the PVC-SOO, but there is no prospective data validation. Purpose This prospective multicenter study sought to analyze the applicability and accuracy of a simple hybrid algorithm that includes electrocardiographic and clinical information in a consecutive patient population with outflow tract (OT) PVCs undergoing catheter ablation. Methods Consecutive patients with frequent OT-PVCs and indication for catheter ablation were prospectively included in 4 centers. The vascular access (femoral vein vs femoral artery) and the first outflow tract to be mapped were decided based on a two-steps hybrid algorithm (see Figure 1) including ECG information [R/S PVC precordial transition (PT): early PT if it occurs before V3; late PT if beyond V3) and clinical information [the following variables compute 1 point in a clinical score: age (>59 y.o); presence of hypertension; and gender (man)]. Results 115 consecutive patients [42 (37%) man, 52 + 15 y.o] were included. Mean PVC burden at baseline was 20 ± 13% and mean LVEF was 59 ± 8%. Mean procedure time was 55 ± 26 min. Complete acute abolition of the PVC was achieved in 110 (96%) patients. 84 (73%) patients had the PVC’s SOO in the right ventricle OT (RVOT) whereas 31 (27%) in the left ventricular OT (LVOT). Compared with patients with a RVOT-SOO, those with a LVOT-SOO were more frequently man [18 (58%) vs 24 (29%), p = 0.004], more frequently suffered from hypertension [18 (58%) vs 15 (18%), p < 0.001) and had an early R/S PVC transition [17 (55%) early PT, 3 (10%) late PT) in the case of LVOT-SOO vs 4 (5%) early PT, 55 (65%) late PT in the case of RVOT-SOO, p < 0.001]. The hybrid algorithm accurately anticipated the PVC’s SOO in 101 (88%) patients. A reduction of at least 80% of PVC burden was achieved by 90% of patients at 6 months. Conclusions The hybrid algorithm, prospectively evaluated in an international multicenter study, has proved to permit to accurately anticipate the PVC’s SOO (right vs left) in a consultive population of patients with OT PVCs. Abstract Figure 1

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Regional pericarditis following uncomplicated catheter ablation procedure: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab525 ◽

2021 ◽

Author(s):

K V Davtyan ◽

A H Topchyan ◽

E A Mershina ◽

V E Sinitsyn

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cardiac Magnetic Resonance ◽

Catheter Ablation ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Cardiac Computed Tomography ◽

Premature Ventricular Complex ◽

Resonance Imaging ◽

Ablation Procedure

Abstract Background Acute post-ablation pericarditis is the most common complication of epicardial ablation of ventricular arrhythmias (VA), while regional pericarditis following an initially uneventful endocardial catheter ablation (CA) procedure is a rare and elusive diagnosis. Case summary We report a case of a 66-years old Russian female who developed chest pain accompanied by ECG changes—biphasic T waves in V1-V4 leads after an initially uncomplicated premature ventricular complex (PVC) CA procedure. After examination and investigations, including transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT), she was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful with the limited number of radiofrequency applications. Furthermore, the diagnosis was difficult due to normal body temperature and the absence of pericardial effusion and myocardial abnormalities on TTE, findings that are not characteristic of pericarditis. The patient's last office visit was in six months after the procedure. Neither patient had any complaints, nor there were any changes on ECG and TTE. Discussion Regional post-ablation pericarditis is a relatively rare type of postcardiac injury syndrome (PCIS). The varying severity of the PCIS clinical course makes the diagnosis of post-ablation pericarditis initially difficult, especially in patients undergoing an uneventful catheter ablation procedure. Non-invasive imaging modalities as cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT) should be considered initially in elusive cases of PCIS.

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Catheter Ablation of a Polymorphic Ventricular Tachycardia Inducing Monofocal Premature Ventricular Complex

Internal Medicine ◽

10.2169/internalmedicine.47.1211 ◽

2008 ◽

Vol 47 (20) ◽

pp. 1799-1802 ◽

Cited By ~ 7

Author(s):

Takashi Uemura ◽

Hiroshige Yamabe ◽

Yasuaki Tanaka ◽

Kenji Morihisa ◽

Hiroaki Kawano ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Polymorphic Ventricular Tachycardia ◽

Premature Ventricular Complex

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Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation

Heart ◽

10.1136/heart.86.1.e3 ◽

2001 ◽

Vol 86 (1) ◽

pp. 3e-3 ◽

Cited By ~ 23

Author(s):

S Takatsuki

Keyword(s):

Catheter Ablation ◽

Ventricular Fibrillation ◽

Premature Ventricular Complex ◽

Idiopathic Ventricular Fibrillation

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Catheter Ablation of Parahisian Premature Ventricular Complex

Korean Circulation Journal ◽

10.4070/kcj.2011.41.12.766 ◽

2011 ◽

Vol 41 (12) ◽

pp. 766 ◽

Cited By ~ 2

Author(s):

Jun Kim ◽

Jeong Su Kim ◽

Yong Hyun Park ◽

June Hong Kim ◽

Kook Jin Chun

Keyword(s):

Catheter Ablation ◽

Premature Ventricular Complex

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Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation

Heart ◽

10.1136/hrt.86.1.e3 ◽

2001 ◽

Vol 86 (1) ◽

pp. e3-e3

Author(s):

S Takatsuki ◽

H Mitamura ◽

S Ogawa

Keyword(s):

Catheter Ablation ◽

Ventricular Fibrillation ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Premature Ventricular Complex ◽

Programmed Electrical Stimulation ◽

Idiopathic Ventricular Fibrillation ◽

Surface Ecg ◽

Cardiac Evaluation ◽

Qrs Morphology

A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment.

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Incidental Detection of a Rare Coronary Anomaly During Catheter Ablation for Premature Ventricular Complexes: All in One Coronary Ostium

Acta Medica ◽

10.32552/2021.actamedica.550 ◽

2021 ◽

pp. 1-3

Author(s):

Yusuf Ziya Şener ◽

Uğur Canpolat ◽

Hikmet Yorgun ◽

Tuncay Hazırolan ◽

Kudret Aytemir

Keyword(s):

Congenital Anomaly ◽

Coronary Artery ◽

Catheter Ablation ◽

Cardiac Death ◽

Essential Role ◽

Premature Ventricular Complex ◽

Single Coronary Artery ◽

Coronary Ostium ◽

Coronary Anomaly ◽

Rare Congenital Anomaly

Single coronary artery is a rare congenital anomaly associated with sudden cardiac death even though most of the cases are asymptomatic. Cardiac computerized tomography angiography plays an essential role in establishing the diagnosis of single coronary artery and designating the arterial course. Being aware of coronary anomaly is crucial in some cases scheduled for catheter ablation of premature ventricular complex neighboring to coronary arteries to prevent radiofrequency ablation related vascular injury.

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