Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang,

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Presentation transcript:

Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang, MD, Chang-Sheng Ma, MD, FHRS, Jian-Min Chu, MD HeartRhythm Case Reports Volume 2, Issue 3, Pages 204-207 (May 2016) DOI: 10.1016/j.hrcr.2015.10.005 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiography of premature ventricular contractions (PVC1 and PVC2) shown as left bundle branch block and right bundle branch block morphology (100 mm/s). HeartRhythm Case Reports 2016 2, 204-207DOI: (10.1016/j.hrcr.2015.10.005) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Activation mapping and pace mapping in right ventricular outflow tract (RVOT) and great cardiac vein (GCV). A: Activation map recorded earliest ventricular activation preceding the QRS onset (V-QRS) as 28 ms in RVOT. B: Activation map recorded V-QRS as 40 ms at the target site in GCV. C, D: Pace maps in GCV presented 2 QRS morphologies at the same site.The stimulus-to-QRS interval of left bundle branch block (LBBB) morphology was longer than that of right bundle branch block (RBBB) morphology (126 ms vs 44 ms). E: Premature ventricular contractions with 2 QRS morphologies that were eliminated after 4.5 seconds of ablation; the last one showed LBBB morphology and the penultimate one showed RBBB morphology (red arrow). HeartRhythm Case Reports 2016 2, 204-207DOI: (10.1016/j.hrcr.2015.10.005) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Fluoroscopic images and anatomic relationship of right ventricular outflow tract (RVOT) and great cardiac vein (GCV). A, B: Left anterior oblique (LAO) (45°) and right anterior oblique (30°) + caudal (20°) (RAO+CAU) (showing left circumflex coronary artery) fluoroscopic images of the mapping catheter and coronary angiography at the target. C: The electroanatomic map presents the relationship between RVOT and GCV. D: CARTO merge presents the relationship between RVOT and GCV. ABL = ablation catheter; AO = aortic; CS = coronary sinus; LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; LM = left main coronary artery; MV = mitral valve; RV = right ventricle; TIG = TIG catheter. HeartRhythm Case Reports 2016 2, 204-207DOI: (10.1016/j.hrcr.2015.10.005) Copyright © 2016 Heart Rhythm Society Terms and Conditions