case_images: PMC9874696_01
case_images: Twelve lead-ECG recorded before the procedure showing sinus rhythm, PVC-1, and PVC-2. ECG, electrocardiogram; PVC, premature ventricular contraction.
case_images: fcvm-09-1008380-g001.jpg
case_images: PMC9874696_01_fcvm-09-1008380-g001.jpg
case_images: F1
case_images: However, a serious of ECGs show frequent bi-morphic PVCs characterized by left bundle branch block (LBBB) and/or right bundle branch block (RBBB) in Figure 1, whose QRS wave were upright in leads II, III, and aVF (an inferior axis).
case_images: Activation mapping of PVCs. (A) Intracardiac ECG (left panel) and electro-anatomic map (right panel) obtained during activation mapping of PVC-1 in the anterior septum of RVOT. (B) Intracardiac ECG (left panel) and electro-anatomic map (right panel) obtained during activation mapping of PVC-2 near the LCC. (C) Intracardiac ECG (left panel) and electro-anatomic map (right panel) obtained during activation mapping of PVC-1 at the L-RCC. The bipolar ECG exhibited the LVP preceding the QRS onset, and electro-anatomic map showed ablation site in different electro-anatomic mapping areas. ECG, electrocardiogram; LCC, left coronary cusp; L-RCC, the left-right coronary cusp commissure; LVP, local voltage potential; MAP1, unipolar ECG; MAP1-2, bipolar ECG; RCC, right coronary cusp; PVC, premature ventricular contraction; RVOT, right ventricular outflow tract.
case_images: fcvm-09-1008380-g002.jpg
case_images: PMC9874696_01_fcvm-09-1008380-g002.jpg
case_images: F2
case_images: RVOT (Figure 2A). Radiofrequency ablations (35 W, 17 ml/min, 2 min, 45 C) in this location reduced the occurrence of PVC-1, but the onset of PVC-2 shortly became frequent. The site of earliest activation (-41 ms before the onset of the surface QRS), was identified near the left coronary cusp (LCC) (Figure 2B). The L-RCC was focused (-44 ms before the onset of the surface QRS) and PVC elimination was achieved after ablation in this location (Figure 2C).