PMC9464845_01
A 12-lead ECG at 10 mm/mV 25 mm/s of the patients on admission.. ECG: Electrocardiogram.
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F1
In addition, PVC showed a left bundle-branch block configuration, monophasic R wave in lead I and aVL, and precordial transition in V3 lead (Fig. 1).
The endocardial electrograms at the para-hisian ablation site exhibiting the earliest ventricular activation during the PVCs. Large His-bundle electrogram was recorded from the Map-d during sinus rhythm and the earliest ventricular activation preceding the QRS by 41 ms was observed during PVC.. PVC: Premature ventricular contraction, Map-d: Bipolar recording from the distal electrode of the ablation catheter.
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F2
PVC, the earliest ventricular activation was identified at the His-bundle region, where a high amplitude His-bundle electrogram could be recorded during the sinus rhythm. PVC activation preceded QRS onset by 41 ms was recorded on the bipolar recording with QS pattern on the unipolar recording and there was a 0.6 mV His potential (Fig. 2).
Distal His-bundle electrogram was recorded from the Map-d during sinus rhythm and the ventricular activation preceding the QRS by 37 ms was observed during PVC at the successful ablation site.. PVC: Premature ventricular contraction; Map-d: Bipolar recording from the distal electrode of the ablation catheter.
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F3
RF ablation was planned to the region, where the His potential amplitude was lower (0.2 mV), the AV ratio was <1, and ventricular activation preceded the QRS onset by 37 ms (Fig. 3).
Simultaneous anatomical and activation mapping using a three-dimensional electroanatomic mapping system at the para-hisian region. Ventricular activation preceding the QRS by 37 ms was observed during PVC at the successful ablation site.. PVC: Premature ventricular contraction.
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F4
Subsequently, irrigated RF current was delivered using a steerable sheath (Agilis, St Jude Medical) in the distal his region with power starting at 15W with an irrigation flow rate of 10 ml/min after PVC was suppressed, RF delivery was applied for a total of 90 s with gradually increasing power to 25 W with an irrigation flow rate of 15 ml/min with maximum temperature of 42 C (Fig. 4a, b).
Post-ablation 12-lead surface ECG.. ECG: Electrocardiogram.
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F5
After ablation, under intravenous isoproterenol infusion (4 mcgr/dk) and burst pacing from the right ventricle no PVCs/VTs were observed during the waiting period of 30 min (Fig. 5).