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Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure
Mapping and ablating premature ventricular complexes (PVCs) that originate near the great cardiac vein (GCV) and anterior interventricular vein (AIV) can pose several challenges related to the advancement and positioning of catheters within these veins, the delivery of effective lesions, and the ris...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MediaSphere Medical
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252828/ https://www.ncbi.nlm.nih.gov/pubmed/32494430 http://dx.doi.org/10.19102/icrm.2017.081001 |
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author | Kumar, Darpan S. Jessel, Peter M. Raitt, Merritt H. Zarraga, Ignatius Gerardo E. |
author_facet | Kumar, Darpan S. Jessel, Peter M. Raitt, Merritt H. Zarraga, Ignatius Gerardo E. |
author_sort | Kumar, Darpan S. |
collection | PubMed |
description | Mapping and ablating premature ventricular complexes (PVCs) that originate near the great cardiac vein (GCV) and anterior interventricular vein (AIV) can pose several challenges related to the advancement and positioning of catheters within these veins, the delivery of effective lesions, and the risk of collateral injury to the left coronary arteries and left phrenic nerve. When ablation of these PVCs from inside the GCV/AIV is not possible, a systematic assessment of nearby vantage points, such as the left coronary cusp (LCC) and left ventricular (LV) endocardial breakout site, should be considered, in addition to the performance of a more invasive epicardial ablation procedure via a percutaneous pericardial puncture or thoracotomy. Several electrocardiographic, anatomic, and electrogram timing features have been shown to predict the likelihood of successful ablation from a non-epicardial site, such as the LCC or LV endocardium, but none of these spots is considered to be a perfect location. The case described here in this report is a demonstration of a safe and successful ablation of GCV PVCs from the LV endocardial breakout site using adequate power and lesion duration, even when the site was 17 mm away from the putative origin, and some previously described electrocardiographic and electrogram-based predictors of success suggested the outcome would not be positive. |
format | Online Article Text |
id | pubmed-7252828 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | MediaSphere Medical |
record_format | MEDLINE/PubMed |
spelling | pubmed-72528282020-06-02 Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure Kumar, Darpan S. Jessel, Peter M. Raitt, Merritt H. Zarraga, Ignatius Gerardo E. J Innov Card Rhythm Manag Complex Case Study Mapping and ablating premature ventricular complexes (PVCs) that originate near the great cardiac vein (GCV) and anterior interventricular vein (AIV) can pose several challenges related to the advancement and positioning of catheters within these veins, the delivery of effective lesions, and the risk of collateral injury to the left coronary arteries and left phrenic nerve. When ablation of these PVCs from inside the GCV/AIV is not possible, a systematic assessment of nearby vantage points, such as the left coronary cusp (LCC) and left ventricular (LV) endocardial breakout site, should be considered, in addition to the performance of a more invasive epicardial ablation procedure via a percutaneous pericardial puncture or thoracotomy. Several electrocardiographic, anatomic, and electrogram timing features have been shown to predict the likelihood of successful ablation from a non-epicardial site, such as the LCC or LV endocardium, but none of these spots is considered to be a perfect location. The case described here in this report is a demonstration of a safe and successful ablation of GCV PVCs from the LV endocardial breakout site using adequate power and lesion duration, even when the site was 17 mm away from the putative origin, and some previously described electrocardiographic and electrogram-based predictors of success suggested the outcome would not be positive. MediaSphere Medical 2017-10-15 /pmc/articles/PMC7252828/ /pubmed/32494430 http://dx.doi.org/10.19102/icrm.2017.081001 Text en Copyright: © 2017 Innovations in Cardiac Rhythm Management http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Complex Case Study Kumar, Darpan S. Jessel, Peter M. Raitt, Merritt H. Zarraga, Ignatius Gerardo E. Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title | Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title_full | Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title_fullStr | Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title_full_unstemmed | Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title_short | Successful Ablation of Epicardial Premature Ventricular Complexes Near the Great Cardiac Vein from the Left Ventricular Endocardium Despite Predictors of Failure |
title_sort | successful ablation of epicardial premature ventricular complexes near the great cardiac vein from the left ventricular endocardium despite predictors of failure |
topic | Complex Case Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252828/ https://www.ncbi.nlm.nih.gov/pubmed/32494430 http://dx.doi.org/10.19102/icrm.2017.081001 |
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