PMC9880889_01
Twelve-lead ECG during sinus and ventricular premature contractions.. The twelve-lead ECG reveals bigeminal ventricular premature contractions.
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The 12-lead ECG presented normal sinus rhythm with frequent VPCs with a left bundle branch block morphology and superior axis (Fig. 1). The tip of the catheter was placed over the valve as close as possible to the earliest point under the valve, where a potential preceding the QRS onset by 26 ms was recorded (Supplementary Fig. 1).
Fluoroscopic view, three-dimensional map, intracardiac electrogram of the PENTARAY catheter, and 12-lead ECG during pace mapping.. A. The fluoroscopic view in the right and left anterior oblique views during PENTARAY mapping is presented. B. The three-dimensional map (left) and local potentials during a ventricular premature contraction (center) and the 12-lead ECG during pace mapping are presented (right). The earliest signal was able to be recorded at electrodes P7-8 (white arrow). Small atrial signals are recorded by electrodes P7-8, P9-10, and P11-12 (white arrowheads), which would indicate that that area was the tricuspid valve annulus. The numbers on the fluoroscopic and three-dimensional maps indicate the distal electrode numbers of the PENTARAY  catheter.
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The earliest potential preceded the QRS onset by 34 ms and was found at the inferolateral aspect of the TA (Fig. 2). Pace mapping from that site produced a very similar QRS morphology to the target VPC (Fig. 2, bottom right panel, PASSO viewer, Biosense Webster, CA, USA).
Fluoroscopic views (A) and three-dimensional map (B) of the RF catheter and local potential at the successful siteand ventricular premature contractions.. The tip of the ablation catheter is placed on the tricuspid valve annulus, and a small atrial signal is recorded from the distal tip of the catheter (Map-d, white arrow) during sinus rhythm. Further, the local potential during a ventricular premature contraction preceded the QRS onset by 37 ms.
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The tip of the sheath was placed in a higher portion of the RV cavity to maintain an adequate distance to allow the tip of the RF catheter to be deflected and placed under the valve (Fig. 3).