Late elimination of challenging idiopathic ventricular arrhythmias originating from left ventricular summit by anatomical ablation

Abstract

Ablation of premature ventricular complexes (PVCs) originating from left ventricular outflow tract (LVOT)/left ventricular summit (LVS) is challenging with considerable rate of failure. Recently, in a novel approach to ablation of these arrythmias, application of radiofrequency energy to anatomically opposite sites of presumed origin of arrythmia, has been associated with moderate procedure success. Although late elimination of PVCs that are persistent following an ablation procedure has been previously reported, this observation has not been studied sufficiently. In this report, firstly, we present three cases of lately eliminated LVS PVCs, then, we discuss possible mechanism of this observation and conclude that after an initial failed attempt of anatomic ablation, operators may choose a period of watchful waiting before attempting a redo procedure.

Idiopathic right ventricular arrhythmias requiring additional ablation from the left‐sided outflow tract: ECG characteristics and efficacy of an anatomical approach

“…Previous studies have reported the utility of the anatomic approach in RF catheter ablation of VAs. [16][17][18] However, in all or almost all cases in those studies, [16][17][18] As shown in this study, there is a possibility that the QRS morphology of a VA originating from the posterior RVOT changes during catheter ablation procedures. 15,[19][20][21] Therefore, a detailed and continuous observation of the QRS morphology is important during the ablation to identify the changes in the QRS morphology.…”

“…Previous studies have reported the utility of the anatomic approach in RF catheter ablation of VAs 16–18 . However, in all or almost all cases in those studies, 16–18 the clinical VAs had characteristic ECG findings of a left‐sided origin, and the earliest activation time was found in the left‐sided OT before the ablation. Therefore, from the beginning, mapping was started from the left‐sided OT, and, in most cases, catheter ablation was performed only in the left‐sided OT.…”

Left Ventricular Summit—Concept, Anatomical Structure and Clinical Significance

“…The superior portion of LVS is dangerous for pericardial penetration. It increases the risk of major and minor complications, such as intrapericardial bleeding, coronary artery stenosis, delayed tamponade and incidental right ventricle puncture [85][86][87][88][89]. Table 1 summarizes possible approaches to the LVS area.…”