Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Epicardial ablation of premature ventricular complexes arising from the summit of the left ventricle
J. H. Kaufmann1, C. Huber1, C. Göbel1, S. Gozolits1, C. Thilo1
1Medizinische Klinik I - Kardiologie, RoMed Klinikum Rosenheim, Rosenheim;

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.   
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.