Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
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Epicardial ablation of premature ventricular complexes arising from the summit of the left ventricle
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J. H. Kaufmann1, C. Huber1, C. Göbel1, S. Gozolits1, C. Thilo1
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1Medizinische Klinik I - Kardiologie, RoMed Klinikum Rosenheim, Rosenheim;
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Methods and results
A 54-year-old man presented with left ventricular
systolic dysfunction (EF 45%) and 28.000 premature ventricular complexes (PVC)
in 24 hours. PVC had a right bundle branch block pattern with inferior axis and
a pseudo-delta wave of 60 ms in precordial leads suggesting an epicardial
origin. Analysis of intracardiac electrograms showed the earliest local ventricular
activation in the distal portion of the great cardiac vein (GCV). Therefore,
epicardial mapping using a 3D mapping system (Carto 3) was performed by
advancing an ablation catheter via the GCV to the left ventricular summit (LVS).
At the LVS a local fragmented bipolar potential and a unipolar QS pattern could
be recorded. Angiography confirmed adequate distance to coronary vessels. During ablation PVC terminated within
10 seconds. At 6 week follow-up PVC burden was 6% (polymorphic) and
echocardiography showed recovery of left ventricular function.
Conclusion
Ablation of frequent PVC can improve cardiac function
in patients with LV dysfunction. Up to 14.5% of idiopathic left ventricular
arrhythmias arise from the LVS. GCV offers a facile epicardial access without
necessity for pericardial puncture and ablation at this site is feasible and
safe considering the complex anatomy of surrounding structures.
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https://dgk.org/kongress_programme/ht2021/P309.htm
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