Premature ventricular contractions arising from the intramural ventricular septum.
A 68-year-old man with symptomatic idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Radiofrequency catheter ablation was unsuccessful at the earliest endocardial ventricular activation site in the left coronary cusp. Epicardial mapping via the cardiac veins was then performed. Balloon-occluded coronary sinus venography revealed the small branches of the anterior interventricular vein. Mapping with a microcatheter revealed the earliest ventricular activation and perfect pace map at the distal portion of the septal perforating branch, suggesting an intramural ventricular septal PVC origin. Catheter ablation was abandoned because of the inaccessibility of the ablation catheter to that site via the venous system.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. takumi-y@fb4.so-net.ne.jp
Okada
Taro
T
Murakami
Yoshimasa
Y
Yoshida
Naoki
N
Murohara
Toyoaki
T
Kay
G Neal
GN
D000368:Aged; D018780:Body Surface Potential Mapping; D006346:Heart Septum; D006801:Humans; D008297:Male; D018879:Ventricular Premature Complexes / Q000175:diagnosis*