Title: Radiofrequency catheter ablation of premature ventricular contractions/ventricular tachycardia originating from the main stem of pulmonary artery
Abstract: Objective The aim of this study is to discuss the electrophysiologic characteristics,body surface electrocardiogram features,mapping methods and catheter ablation strategy of premature ventricular contractions or tachycardias(PVCs/VT)originating from the main stem of pulmonary artery(MSPA).Methods Twenty-seven consecutive patients with ECG documentation of PVCs/VT with the feature of right ventricular outflow tract origin were referred for catheter ablation,4[3 male,mean age(25±10)years old]of which (15%)were found to be MSPA origin by pulmonary artery angiogram.Noncontact mapping were used in 3 ca- ses and rountine activation mapping and pace mapping in one case.Radiofrequency energy was delivered through temperature controlled ablation catheter in 2 patients and irrigation catheter in other 2 cases. Results All the patients did not have any sign to suggest structural heart disease except one(N_4)with sus- pect of arrhythmogenic right ventricular cardiomyopathy.All 4 patients had the symptom of palpitation during PVC/VT attack,but only one had syncope.Surface ECG of PVC/VT showed a great QRS amplitude in the in- ferior leads,right QRS axis deviation and big Q_(avL)/Q_(aVR)ratio.Noncontact mapping suggested the earliest acti- vation(EA)point was far from the above of the center of EnSite Array with a longer distance between EA point and the breakout point.Endocardial recording of the target site showed a mean of(28±6)ms proceding the onset of QRS complex,with equal atrial and ventricular electrogram in 2 patients,a fusion of spike or fractiona- ted potential and the ventricular elctrogram in 3 patients.Perfect pace map could be done with higher output in all patients.Catheter ablation was all successful.After a mean follow-up of(6.5±3.0)months,1 patient had PVC recurrence and need a second successful ablation above the pulmonary valve.Conclusion PVCs/VT originating from MSPA is not uncommon.Its diagnosis can be rapidly made by noncontact mapping but needs to be confirmed by pulmonary artery angiogram.Detailed activation mapping and pace mapping should be done above the pulmonary valve to guide the successful catheter ablation.
Publication Year: 2007
Publication Date: 2007-01-01
Language: en
Type: article
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