Volume 13, Issue 1, Pages (January 2016)

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Volume 13, Issue 1, Pages 72-77 (January 2016) Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias Miki Yokokawa, MD, Dae Yon Jung, PhD, Alfred O. Hero III, PHD, Kazim Baser, MD, Fred Morady, MD, FACC, Frank Bogun, MD, FACC Heart Rhythm Volume 13, Issue 1, Pages 72-77 (January 2016) DOI: 10.1016/j.hrthm.2015.08.032 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Pace maps from a patient with an intramural ventricular arrhythmia. Left panel: A 12-lead electrocardiogram (ECG) of the targeted premature ventricular complex (PVC) (black) with the superimposed signal of a pace map (blue) obtained from the coronary venous system where the earliest electrical activation (−30 ms) was recorded within the great cardiac vein (GCV). The correlation coefficient between the targeted PVC and the pace map was 0.82 and the root mean square (RMS) was 246. Left middle panel: A 12-lead ECG of the targeted PVC (black) with the superimposed signal of a pace map (pink) obtained from the site of earliest endocardial activation (−28 ms) within the right ventricular outflow tract (RVOT). The correlation coefficient between the pace map and the PVC was 0.76 and the RMS was 227. Right middle panel: A 12-lead ECG of the targeted PVC (black) with the superimposed signal of a pace map (green) obtained from the combination of the pace maps from the GCV and the RVOT (GCV + RVOT). The correlation coefficient between the combination of the pace maps and the PVC was 0.91 and the RMS was 190. Right panel: A 12-lead ECG of the targeted PVC (black contours) with the superimposed signal of a pace map obtained from within a perforator vein (red), which was the site of origin (SOO). At this site, the activation time was −35 ms. The correlation coefficient was 0.98, and the RMS was 161. B: Position of catheters where pacing was performed in Figure 1A. Three-dimensional reconstruction of echocardiography-derived contours showing a posterior view of the left and right ventricles. The mitral valve annulus (MVA), RVOT, pulmonary artery (PA), aortic cusps, and tricuspid valve (TV) are shown. One catheter is located in the GCV, and another catheter is located in the RVOT. The catheters were projected on the map and were used sequentially for pacing. PM = pace mapping. Heart Rhythm 2016 13, 72-77DOI: (10.1016/j.hrthm.2015.08.032) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Pace maps (PM) from a patient with a nonintramural ventricular arrhythmia. Left panel: A 12-lead electrocardiogram (ECG) of the targeted premature ventricular complex (PVC) (black) with the superimposed signal of a pace map (blue) obtained from the site of (SOO) earliest activation (activation time −29 ms) within the left ventricular outflow tract (LVOT). The correlation coefficient was 0.96, and the root mean square (RMS) was 157. Ablation at this site eliminated the PVC. Right panel: A 12-lead ECG of the targeted PVC (black) with the superimposed signal of a combination of the pace maps (green) from the LVOT and great cardiac vein (GCV), where the activation time was −12 ms. The correlation coefficient of the combination pace maps was 0.87, and the RMS was 204. B: Position of catheters where pacing was performed in Figure 2A. Top panel: Three-dimensional reconstruction of echocardiographic contours showing the posterior view of the left ventricle. The mitral valve annulus (MVA) and aortic cusps are shown. Catheters are placed in the GCV (left top) and LVOT, where the ventricular arrhythmia originated (right top). Bottom panel: Fluoroscopic view of the mapping catheter located in the GCV (left panel) and in the LVOT (right panel). Heart Rhythm 2016 13, 72-77DOI: (10.1016/j.hrthm.2015.08.032) Copyright © 2016 Heart Rhythm Society Terms and Conditions