Thirty-two-year-old woman with drug-refractory symptomatic outflow PVCs referred for ablation. She was brought to the electrophysiology laboratory for.

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Date of download: 6/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: The V2 Transition Ratio: A New Electrocardiographic.

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Thirty-two-year-old woman with drug-refractory symptomatic outflow PVCs referred for ablation. She was brought to the electrophysiology laboratory for an electrophysiology study and radiofrequency ablation procedure. A. A mapping catheter is placed in the anterior-septal RVOT at the site of origin of the PVC. Pacing from this site demonstrates a 12-lead QRS morphology that matches the spontaneously occurring PVC (subsequent beat). B. Three-dimensional electroanatomic map (Carto, Biosense, Diamond Bar, CA). AP view is shown. Earliest activation pre-QRS is noted in red, latest sites in blue. The earliest site is shown in the anterior RVOT. C. Left anterior oblique (LAO) fluoroscopic position of ablation catheter at the RVOT ablation site positioned by the Niobe magnetic navigation system (Stereotaxis, Inc.); also shown are right atrial (RA), His, and coronary sinus (CS) catheters. D. The electrogram at the site of earliest activation (red arrow) was 40 ms pre-QRS. E. A single radiofrequency ablation lesion successfully eliminates the PVC (orange arrow) after an initial increase in activity after RF was turned on. ABL, ablation catheter; CS, coronary sinus catheter; HIS, His bundle catheter; LBBB, left bundle branch block; PVC, premature ventricular contraction; RA, right atrial catheter; RV, right ventricular; RVOT, right ventricular outflow tract. Source: VENTRICULAR ARRHYTHMIAS, Hurst's The Heart, 14e Citation: Fuster V, Harrington RA, Narula J, Eapen ZJ. Hurst's The Heart, 14e; 2017 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/2046/hurst14_ch85_f003.png&sec=155641188&BookID=2046&ChapterSecID=155641162&imagename= Accessed: December 28, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved