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Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber  Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault,

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Presentation on theme: "Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber  Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault,"— Presentation transcript:

1 Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber 
Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault, MD, Lena Rivard, MD, MSc, FHRS  HeartRhythm Case Reports  Volume 2, Issue 5, Pages (September 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 Pre-excitation induced by atrial pacing with the same morphology as the clinical premature ventricular contractions (PVCs). A: Recordings of the surface 12-lead electrocardiogram (ECG) with monomorphic spontaneous “PVCs.” B: Recordings of the surface 12-lead ECG during the electrophysiology study with incremental atrial pacing and an atrial premature pacing at 390 ms. The QRS morphology during maximum pre-excitation is similar to the spontaneous “PVC.” HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 Surface electrocardiogram, intracardiac electrograms, and electrode positions during sinus rhythm and premature ventricular contraction (PVC). Surface leads II, III, and V1 and intracardiac electrograms are shown at the successful ablation site. During the PVC, the distal unipolar electrogram recorded by the ablation catheter (MAP UNI) demonstrates a QS pattern and the bipolar recording indicates that the signal is 20 ms earlier than the surface QRS onset (blue calipers). The Purkinje signal is indicated by the arrow. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Surface 12-lead electrocardiogram showing the automatic rhythm induced during radiofrequency ablation at the site of earliest premature ventricular contraction (PVC) activation, leading to an automatic irregular rhythm with the same left bundle branch block morphology. B: Intracardiac recordings from the coronary sinus (CS) and MAP catheters show AV dissociation during ventricular automaticity induced by radiofrequency ablation. C: Electroanatomic activation map of PVCs in the anteroposterior view. The earliest site of activation during PVCs is located in the apicolateral region of the right ventricle. Radiofrequency ablation was performed during sinus rhythm at this site (blue circle). HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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