Premature ventricular contractions with acute successful radiofrequency catheter ablation near the atrioventricular node using reversed C curve technique

BACKGROUND: We sought to clarify the electrophysiological (EP) characteristics of premature ventricular contractions (PVCs) with acute successful radiofrequency catheter ablation (RFCA) near the atrioventricular node (AVN). METHODS AND RESULTS: Eighteen patients with acute successful RFCA near the AVN were included in this study. Systematic mapping was performed with two mapping methods: antegrade mapping technique (group A) and reversed C curve mapping technique (group R). RFCA was preferentially performed underneath the tricuspid valve (TV) with reversed C curve technique in all patients. The a amplitude/v amplitude ratio during sinus rhythm in group A was significantly larger than in group B (0.19 ± 0.10 vs 0.06 ± 0.02, p < 0.01). The earliest bipolar activation preceded the QRS onset in group A was significantly smaller than in group R (19.6 ± 4.9 vs 24.4 ± 6.6 ms (ms), p < 0.01). Pace mapping in group A and group R demonstrated perfect QRS morphology (12/12) match only in 5.6% (one patient) and 16.7% (3 patients) of patients, respectively. The mean duration of successful RFCA was 8.2 ± 2.4 s in 13 patients (72.2%). Early (within 3 days) and late (one-year) recurrence rates were 5.6% (one patient) and 16.7% (3 patients), respectively. No atrioventricular block occurred during RFCA or the one-year follow up. CONCLUSIONS: PVCs near the AVN are a subgroup of idiopathic PVCs with distinctive EP features. RFCA using reversed C curve technique is effective and safe for the acute elimination of these challenging AVN-PVCs.