Korean Circ J.  2011 Dec;41(12):766-769. 10.4070/kcj.2011.41.12.766.

Catheter Ablation of Parahisian Premature Ventricular Complex

• Kim J
• Kim JS
• Park YH
• Kim JH
• Chun KJ

• KMID: 1776256
• DOI: http://doi.org/10.4070/kcj.2011.41.12.766

Abstract

Catheter ablation is performed in selected patients with a symptomatic premature ventricular complex (PVC) or PVC-induced cardiomyopathy. Ablation of PVC from the His region has a high risk of inducing a complete atrioventricular block. Here we report successful catheter ablation of a parahisian PVC in a 63-year-old man.

Keyword

Premature ventricular complexes; Bundle of His; Catheter ablation

MeSH Terms

Atrioventricular Block
Bundle of His
Cardiomyopathies
Catheter Ablation
Catheters
Humans
Middle Aged
Ventricular Premature Complexes

Figure

• 

  Fig. 1 A 12-lead electrocardiogram of the patient (A). Premature ventricular complex in bigeminal pattern is shown. Surface electrocardiogram I, II, V 1, V6 together with intracardiac electrograms from the proximal and distal bipolar electrograms in the His region (HIp HIS d) are displayed from top to bottom (B). Local ventricular activation in the His recording area is earlier than onset of PVC by 18 ms.

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  Fig. 2 Surface electrocardiogram I, II, V 1, V6 together with intracardiac electrograms from the proximal and distal bipolar electrograms in the His region (HIp HIS d) and proximal, distal bipolar and unipolar electrogram andablation catheter (ABLp, ABLd and ABLuni) are displayed from top to bottom. Local ventricular activation was earlier at the unsuccessful ablation site than the onset of PVC by 24 ms (A). Right anterior oblique (RAO) and left anterior oblique (LaO) fluoroscopic views of unsuccessful ablation site. Ablation catheter (ABL) is located a few millimeter anterior and inferior to the His recording catheter (HIS) (B and C). Also shown is a catheter in the right ventricular apex (RVA). Local ventricular activation was earliest at the successful ablation site than the onset of PVC by 35 ms (D). RAO and LAO fluoroscopic views of successful ablation site (E and F). Compared with B and C, ablation catheter (ABL) is located a few millimeter anterior and superior to the His recording catheter (HIS).

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  Fig. 3 A 12-lead electrocardiogram during application of radiofrequency energy. After application of RF energy there was immediate disappearance of premature ventricular complex.

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  Fig. 4 Pacemapping at the successful ablation site. Morphology of QRS complex during pacing by ablation catheter at the ablation site is same with morphology of PVC in all 12 leads.

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