Catheter ablation of idiopathic ventricular arrhythmias originating from left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein

An Alternative Way to Reach the Epicardial Focus of the Left Ventricular Tachycardia in a Patient with Non-ischemic Cardiomyopathy

“…A maximum deflection index of ≥0.55 has also high sensitivity and specificity, 100% and 99%, respectively [9]. Similar to these findings, Li et al [7] have found that the prolonged intrinsicoid deflection time >70 ms and maximum deflection index >0.54 suggested the epicardial site with high sensitivity (83% for both) and specificity (96% and 97%, respectively). In our case, we measured the pseudodelta as 50 ms, the intrinsicoid deflection time as 96 ms, and maximum deflection index as 0.59 suggesting an epicardial site for the VT. Before attempting to enter the pericardial space, the venous system of the ventricles such as coronary sinus and its branches should be mapped to identify the origin of VT in patients having pseudodelta, prolonged intrinsicoid deflection time and higher maximum deflection index.…”

“…Previously published several recent reports have demonstrated that the venous system of the heart seems to be alternative route for mapping and ablation of VTs originating from an epicardial region [4-6]. Li et al [7] have demonstrated that ECG patterns of ventricular arrhythmias arising from the different parts of the venous system including great cardiac vein and anterior interventricular vein were different, pace mapping and ablation from these sites were effective and safe. The venous system of the ventricles should be kept in mind when ablation attempts from the endocardial site are unsuccessful.…”

Analysis of Morphological Characteristics and Origins of Idiopathic Premature Ventricular Contractions Under a 12-Lead Electrocardiogram in Children with Structurally Normal Hearts

“…With the development of electrophysiology and radiofrequency ablation, several studies [9][10][11][12][13] have described the criteria to distinguish PVC origin according to the features of the 12-lead electrocardiogram. Site-specific crite- ria of PVCs also have been reported in these studies.…”

“…7) PVCs usually originate in the right ventricular outflow tract (RVOT), tricuspid annulus, left ventricular anterior or posterior branch, mitral annulus, left ventricular outflow tract, aortic root, and epicardium. 8) Previous studies [9][10][11][12][13] showed that morphological characteristics under a 12-lead electrocardiogram had high diagnostic value for differentiating the origin of PVCs in the adult population. However, electrocardiographic characteristics and origin of idiopathic PVCs in children have not been fully clarified.…”

Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein

“…It has been demonstrated that catheter ablation may be a reliable technique for curing ventricular arrhythmias originating from the great cardiac vein (GCV),1, 2, 3 and there are some challenges and risks with this therapeutic method 4 . Although some reports described successful catheter ablation of ventricular tachycardias originating from the GCV, premature ventricular contractions (PVCs) with left bundle branch block (LBBB) and right bundle branch block( RBBB) with a right inferior axis originating from a single focus in the GCV has rarely been reported.…”