Radiofrequency ablation of premature ventricular contractions originating from the aortomitral continuity localized by use of a novel noninvasive epicardial.

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HeartRhythm Case Reports

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Radiofrequency ablation of premature ventricular contractions originating from the aortomitral continuity localized by use of a novel noninvasive epicardial and endocardial electrophysiology system Erik Wissner, MD, PhD, FHRS, Ardan M. Saguner, MD, Andreas Metzner, MD, PhD, Mikhail Chmelesky, MD, Alexey Tsyganov, MD, Sebastian Deiss, MD, Tilman Maurer, MD, Karl-Heinz Kuck, MD, PhD, FHRS HeartRhythm Case Reports Volume 2, Issue 3, Pages 255-257 (May 2016) DOI: 10.1016/j.hrcr.2016.02.004 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 The 12-lead surface electrocardiography showing ventricular bigeminy with right bundle branch block morphology, inferior axis, positive concordance, and negative QS-complex in lead aVL. HeartRhythm Case Reports 2016 2, 255-257DOI: (10.1016/j.hrcr.2016.02.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Image on left shows noninvasive isochronal epicardial map reconstructed on the 3-dimensional (3-D) biventricular heart model. The zone of earliest activation (red) was identified close to the aortomitral continuity on the epicardial surface. Image on right shows noninvasive isochronal endocardial map reconstructed on the 3-D biventricular heart model in posterior-anterior projection. The zone of earliest activation (red) was identified close to the aortomitral continuity on the endocardial surface. Ao = aorta; LV = left ventricle; RV = right ventricle; RVOT = right ventricular outflow tract. HeartRhythm Case Reports 2016 2, 255-257DOI: (10.1016/j.hrcr.2016.02.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Invasive endocardial 3-dimensional (3-D) activation map of the left ventricle (colored) and invasive 3-D anatomic map of the aortic root (gray). The zone of earliest activation (orange) during premature ventricular contraction (PVC) (preceding the QRS-complex in surface lead II by 24 ms) was identified close to the aortomitral continuity, correlating well with the noninvasive maps (mitral valve indicated by the blue area). Ablation was performed in this area (red dots) and abolished the PVC. HeartRhythm Case Reports 2016 2, 255-257DOI: (10.1016/j.hrcr.2016.02.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions