Author + information
- Received July 25, 2016
- Accepted August 4, 2016
- Published online March 20, 2017.
- Reginald T. Ho, MD∗ (, )
- Daniel R. Frisch, MD and
- Arnold J. Greenspon, MD
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Reginald T. Ho, Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, 925 Chestnut Street, Mezzanine Level, Philadelphia, Pennsylvania 19107.
A 44-year-man presented with an out-of-hospital ventricular fibrillation (VF) arrest and subsequently experienced more than 50 external defibrillator shocks despite intravenous lidocaine and amiodarone. Twelve-lead electrocardiography did not show early repolarization. Results of coronary angiography and echocardiography were normal. VF episodes were triggered by unifocal, tightly coupled premature ventricular contractions with left bundle branch block configuration, late precordial transition, and left superior axis (Figure 1A). Using intracardiac echocardiography, a PENTARAY catheter (Biosense Webster, Diamond Bar, California) was placed on top of the moderator band (MB)–papillary muscle complex, where it recorded multiple Purkinje potentials (Figure 1B, white arrows). A THERMOCOOL SMARTTOUCH ablation catheter (Biosense Webster) positioned on the MB alongside the PENTARAY catheter recorded a sharp Purkinje potential during sinus rhythm that preceded premature ventricular contraction onset by 103 ms (Figure 1C, black arrows). Radiofrequency energy application to this site and along the MB abolished all Purkinje potentials. Complete right bundle branch block developed. The patient underwent insertion of an implantable cardioverter-defibrillator but has had no VF since ablation.
Idiopathic VF due to tightly coupled premature ventricular contractions arising from the MB is a rare cause of sudden death in patients with structurally normal hearts (1). In this case, high-resolution PENTARAY mapping of the MB as it crossed the cavity of the right ventricle from septum to lateral margin facilitated successful ablation.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 25, 2016.
- Accepted August 4, 2016.
- 2017 American College of Cardiology Foundation