PMC5412627_01
Images highlight the right coronary cusp (RCC) as the site of origin for the clinical premature ventricular depolarizations (VPDs). Delivery of premature pacing extrastimulus (*) from the RCC achieved an improved pace map match correlating with the QRS morphology of the clinical VPD. A: Electrocardiographic correlation of pace maps from premature extrastimulus pacing to clinical VPD. B: Successful ablation site on the CARTOSound reconstruction of the right ventricular outflow tract (RVOT) and RCC. LCC, left coronary cusp.
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A 40-year-old man with symptomatic VPDs with a left bundle inferior axis (Figure 1A) was refractory to medical therapy and was referred for ablation. Good pace maps were recorded from right ventricular outflow tract septum pacing and with premature extrastimuli pacing at a coupling interval of 300 ms from the right coronary cusp (Figure 1A). Radiofrequency energy was delivered successfully from the right coronary cusp at the site of the good pace map match and the earliest activation (Figure 1B).
PMC5412627_02
Representative case of left coronary cusp (LCC) origin premature ventricular depolarization (VPD). Pacing prematurity (*) from the LCC matched the QRS morphology of VPD. A: Clinical VPD and electrocardiograms of pace-mapping. B: Successful ablation site. NCC, noncoronary cusp; RCC, right coronary cusp; RV, right ventricle.
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A 57-year-old man with symptomatic VPDs with a right bundle inferior axis (Figure 2A) that was refractory to medical therapy presented for catheter ablation. The best pace-mapping QRS match was observed by delivering premature extrastimuli at the left coronary cusp at a coupling interval of 300 ms (Figure 2A). Radiofrequency energy was delivered successfully from the left coronary cusp at this site (Figure 2B).