Author + information
- M. Barmeda,
- M. Stucky,
- J.T. Shirazi,
- J.M. Miller and
- R. Jain
Premature ventricular complexes (PVCs) are commonly seen. Management options include removing causal agents (e.g., caffeine), antiarrhythmic medications or radiofrequency (RF) ablation. We report 2 cases in which PVCs were suppressed/eliminated by mapping catheter contact without RF application.
Electrophysiology study was performed in 2 men (46 and 61 years old) with a symptomatic PVC burden of 27% (ejection fraction [EF] 45%) and 37% (EF 50%) respectively. In case 1, PVC had right bundle branch block, left inferior axis morphology; in case 2 it was left bundle left inferior axis (Fig. 1, panel A and B). The coronary sinus catheter was positioned at the transition portion from the great cardiac vein and anterior interventricular vein. Activation mapping and pace mapping was done.
In case 1, earliest pre-potentials (fragmented electrograms) were seen 36 ms (Fig. 1, Panel C) prior to QRS onset, at a site that was 4 mm away from the branch point of OM1 from LCX (Fig. 1, Panel D). In case 2, they were seen 26 ms prior to the onset of QRS, in the pulmonary artery. Pacematch was 95% in both cases. Rubbing the ablation catheter at the site in case 1 resulted in complete elimination of PVCs. In case 2, pressure at the site resulted in suppression of PVC (Fig. 1, panel E). In case 1, ablation was never performed because of proximity to coronary arteries. In 1.5 yr follow up, the PVC burden is <1%. In case 2, PVCs were transiently suppressed.
These two cases illustrate the site of origin of PVCs can be very superficial and may be suppressed/eliminated by mild mechanical trauma.