ABSTRACT
A 38-year-old woman with a structurally normal heart was referred for catheter ablation due to symptomatic, monomorphic, high burden (12%) premature ventricular complexes (PVC) refractory to medical therapy. The PVC's ECG morphology suggested an origin in the proximal left anterior fascicle (LAF). During procedure PVCs were mechanically suppressed. Consequently, selection of the ablation target site was based on pace-mapping. This case illustrates how ablation from the right coronary cusp (RCC) for PVC arising from the proximal LAF could be accurately guided by pace-mapping. At this location, pacing can result in both a selective and a non-selective capture of the proximal LAF.
Subject(s)
Body Surface Potential Mapping , Bundle of His , Catheter Ablation , Ventricular Premature Complexes , Adult , Aortic Valve/surgery , Bundle of His/physiopathology , Bundle of His/surgery , Catheter Ablation/methods , Electrocardiography , Electrophysiologic Techniques, Cardiac , Female , Humans , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/surgeryABSTRACT
Owing to the rapid development of new electrophysiologic techniques, our understanding of arrhythmias and their underlying mechanisms has reached unprecedented levels. In some cases, baseline ECG alterations can be identified before arrhythmia development; early recognition of these alterations is of utmost importance to start appropriate preventive therapies and stratify the risk according to patients' outcomes. Hereby, we report a systematic revision of main baseline ECG abnormalities and their implications on clinical outcomes.
