Mapping signatures of ventricular ectopy of endocavitary origin
File(s)
Author(s)
Ng, FS
Rashid, M
Lim, E
Lim, PB
Type
Journal Article
Abstract
A 53-year-old man with very frequent ventricular ectopic activity (39.4% burden) and a structurally normal heart was admitted for percutaneous ablation. Electrocardiography showed a bigeminal unifocal ventricular ectopic pattern, with a right bundle branch block configuration and superior axis, indicating likely origin at the inferior left ventricle.
During mapping at the inferior left ventricle, multiple sites with good morphological match to the ectopic beats during pace mapping, and with early local electrograms relative to the QRS complex, were identified. Despite this, the proximal electrograms at these sites consistently preceded the distal bipolar electrograms (Figure 1A) with the mapping catheter oriented perpendicularly to the inferior left ventricular wall (Figures 1B and 1C). Figure 1D shows the good pace matches obtained from these sites. The locations of these sites were roughly in a circle (Figure 1B), presumed to represent sites encircling the posteromedial papillary muscle, with the origin of the ectopic activity at the mid–papillary muscle, which would account for the consistent finding of proximal electrograms preceding distal electrograms at the surrounding sites.
During mapping at the inferior left ventricle, multiple sites with good morphological match to the ectopic beats during pace mapping, and with early local electrograms relative to the QRS complex, were identified. Despite this, the proximal electrograms at these sites consistently preceded the distal bipolar electrograms (Figure 1A) with the mapping catheter oriented perpendicularly to the inferior left ventricular wall (Figures 1B and 1C). Figure 1D shows the good pace matches obtained from these sites. The locations of these sites were roughly in a circle (Figure 1B), presumed to represent sites encircling the posteromedial papillary muscle, with the origin of the ectopic activity at the mid–papillary muscle, which would account for the consistent finding of proximal electrograms preceding distal electrograms at the surrounding sites.
Date Issued
2016-09-14
Date Acceptance
2016-08-05
Citation
JACC: Clinical Electrophysiology, 2016, 3 (2), pp.186-188
ISSN
2405-5018
Publisher
Elsevier
Start Page
186
End Page
188
Journal / Book Title
JACC: Clinical Electrophysiology
Volume
3
Issue
2
Copyright Statement
© 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
British Heart Foundation
Grant Number
PG/15/20/31339
Publication Status
Published