Premature ventricular contractions with a right bundle branch block and inferior QRS axis morphology: where is the site of the origin?
A 63-year-old woman with symptomatic premature ventricular contractions (PVCs) underwent electrophysiologic testing. The PVCs were suggested to originate from the infra-aortic valvular left ventricular outflow tract because the PVCs had S-waves in leads I, V5, and V6, and an R/S ratio >1 in lead V(1). However, during some PVCs without S-waves, the ST segment had negative retrograde P-waves with a longer ventricularatrial (VA) interval. A Radiofrequency (RF) application in the left coronary cusp completely eliminated the PVCs, suggesting that negative retrograde P-waves might have been observed as pseudo S-waves during the PVCs.
Division of Cardiovascular Diseases, Cardiac Rhythm Management Laboratory, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35294, USA. takumi-y@fb4.so-net.ne.jp
Takumi
T
Yamada
Jose F
JF
Huizar
Hugh T
HT
McElderry
G Neal
GN
Kay
D002037:Bundle-Branch Block / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008875:Middle Aged; D018754:Ventricular Dysfunction / Q000503:physiopathology*; D018879:Ventricular Premature Complexes / Q000503:physiopathology* / Q000601:surgery