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Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach

The left ventricular (LV) summit is the usual source of epicardial idiopathic premature ventricular contractions (PVCs). A 56-year-old male patient presented to the cardiology outpatient clinic with palpitations and dyspnea. Twelve-lead electrocardiography performed on admission revealed monomorphic...

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Autor principal: Aksan, Gökhan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MediaSphere Medical 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588238/
https://www.ncbi.nlm.nih.gov/pubmed/33123415
http://dx.doi.org/10.19102/icrm.2020.111004
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author Aksan, Gökhan
author_facet Aksan, Gökhan
author_sort Aksan, Gökhan
collection PubMed
description The left ventricular (LV) summit is the usual source of epicardial idiopathic premature ventricular contractions (PVCs). A 56-year-old male patient presented to the cardiology outpatient clinic with palpitations and dyspnea. Twelve-lead electrocardiography performed on admission revealed monomorphic PVCs with precordial QRS transition in the V1 derivation and an rS pattern in the D1 derivation and inferior axis. An electrophysiology study and ablation procedure were planned. Activation mapping guided by a three-dimensional electroanatomic system was conducted to identify the earliest site of ventricular activation of the PVCs. During the PVCs, the earliest ventricular activation was observed within the great cardiac vein (GCV) and preceded the QRS onset by 37 ms. Coronary angiography was performed before ablation in the coronary venous system (CVS) to assess the distance from the coronary artery, which showed severe stenosis in the left circumflex artery. Then, percutaneous coronary intervention was performed to address the left circumflex artery stenosis. Anatomic catheter ablation was performed in the aortic cusp and endocardial LV outflow tract, the sites adjacent to the LV-summit PVC origin. However, successful ablation could not be achieved. Subsequently, an irrigated radiofrequency current was delivered in the GCV for 60 seconds, with the power being gradually increased to 30 W and with an irrigation flow rate of 30 mL/min. After ablation, under isoproterenol infusion and burst pacing from the right ventricle, no PVC or ventricular tachycardia was observed. Special precautions should be taken to avoid coronary artery damage during ablation from distal CVS. This approach may increase the success of ablation and avoid potential complications.
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spelling pubmed-75882382020-10-28 Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach Aksan, Gökhan J Innov Card Rhythm Manag Case Report The left ventricular (LV) summit is the usual source of epicardial idiopathic premature ventricular contractions (PVCs). A 56-year-old male patient presented to the cardiology outpatient clinic with palpitations and dyspnea. Twelve-lead electrocardiography performed on admission revealed monomorphic PVCs with precordial QRS transition in the V1 derivation and an rS pattern in the D1 derivation and inferior axis. An electrophysiology study and ablation procedure were planned. Activation mapping guided by a three-dimensional electroanatomic system was conducted to identify the earliest site of ventricular activation of the PVCs. During the PVCs, the earliest ventricular activation was observed within the great cardiac vein (GCV) and preceded the QRS onset by 37 ms. Coronary angiography was performed before ablation in the coronary venous system (CVS) to assess the distance from the coronary artery, which showed severe stenosis in the left circumflex artery. Then, percutaneous coronary intervention was performed to address the left circumflex artery stenosis. Anatomic catheter ablation was performed in the aortic cusp and endocardial LV outflow tract, the sites adjacent to the LV-summit PVC origin. However, successful ablation could not be achieved. Subsequently, an irrigated radiofrequency current was delivered in the GCV for 60 seconds, with the power being gradually increased to 30 W and with an irrigation flow rate of 30 mL/min. After ablation, under isoproterenol infusion and burst pacing from the right ventricle, no PVC or ventricular tachycardia was observed. Special precautions should be taken to avoid coronary artery damage during ablation from distal CVS. This approach may increase the success of ablation and avoid potential complications. MediaSphere Medical 2020-10-15 /pmc/articles/PMC7588238/ /pubmed/33123415 http://dx.doi.org/10.19102/icrm.2020.111004 Text en Copyright: © 2020 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 Case Report
Aksan, Gökhan
Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title_full Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title_fullStr Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title_full_unstemmed Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title_short Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach
title_sort catheter ablation of left ventricular summit arrhythmia in a patient with critical coronary artery stenosis: a sequential approach
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588238/
https://www.ncbi.nlm.nih.gov/pubmed/33123415
http://dx.doi.org/10.19102/icrm.2020.111004
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