title: Transcatheter ablation through the cardiac veins in a patient with a biventricular device and left ventricular epicardial arrhythmias.
abstract: Left ventricular outflow tract (LVOT) may be a source of repeated premature ventricular complexes (PVCs). In symptomatic patients, radiofrequency catheter ablation (RFCA) can be effective, either from endocardial or from epicardial sites. A 50-year-old patient, with dilated cardiomyopathy (DCM) and severe left ventricular (LV) dysfunction, left bundle branch block (LBBB), New York Heart Association (NYHA) class IV, received a biventricular implantable cardioverter/defibrillator (ICD) in 2002. Despite drug therapy, PVCs were frequent (21.019/24 h) including prolonged runs, prompting ICD intervention. Premature ventricular complexes showed an inferior axis morphology, with an R/S ratio in V3>1, suggesting an LVOT origin. Despite the cardiac resynchronization therapy (CRT) device, successful RFCA was performed through the anterior venous branch, with a favourable clinical outcome. To our knowledge, this is the first case describing epicardial RFCA of a PVC focus from cardiac veins in the presence of a CRT device.
authors.affiliation: Cardiac Arrhythmia Center and Electrophysiology Laboratory, St Ambrogio's Clinical Institute, University of Milan, Via Faravelli 16, Milan 20149, Italy. massimo.mantica@grupposandonato.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Mantica
authors.forename: Lucia
authors.initials: L
authors.lastname: De Luca
authors.forename: Rafael
authors.initials: R
authors.lastname: Fagundes
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
mesh_terms: D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D014680:Veins / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*; D018879:Ventricular Premature Complexes / Q000150:complications / Q000601:surgery* / Q000628:therapy