PMC3103894_01
(a) Baseline ECG showing a premature ventricular extrasystole displaying a qR pattern in lead V1; (b) intracardiac tracing during left ventricular mapping (MapD) showing the earliest local activation at the basal left ventricle; (c) pace mapping at this location demonstrated "perfect match" (12 of 12 leads) with the morphology of the premature ventricular extrasystoles.
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fig1
Baseline ECG showed sinus rhythm and frequent premature ventricular extrasystoles (PVEs) with a relatively narrow QRS complex (115 ms), an inferior axis (tall R waves in leads II, III, and aVF), a qR pattern in lead V1 with no transition zone, and absence of S wave in lead V5 or V6 (Figure 1(a)). PVEs (preceding the onset of the surface QRS by 40 ms) was identified at the aortomitral continuity of the basal LV (Figure 1(b)). Pace mapping at this location demonstrated "perfect match" (12 of 12 leads) with the morphology of the PVEs (Figure 1(c)).
Activation mapping of the premature ventricular extrasystoles performed using a 3-dimentional electroanatomical mapping system revealed the earliest ventricular activation at the aortomitral continuity. Energy delivery (red dots) at this region abolished all the premature ventricular extrasystoles. AV: aortic valve; MV: mitral valve.
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fig2
The first radiofrequency (RF) energy application (target temperature of 60 C, 30 W, 60 s, and impedance drop of 5-10 ohms) abolished all the PVBs arising from the aortomitral continuity (Figure 2). Additional RF applications (total ablation time up to 180 s) were delivered at this region in order to ensure a long-term success (red dots in Figure 2).