Volume 12, Issue 4, Pages (April 2015)

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Volume 12, Issue 4, Pages 706-713 (April 2015) Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy Moutaz El Kadri, MD, Miki Yokokawa, MD, Troy Labounty, MD, Gisela Mueller, MD, Thomas Crawford, MD, Eric Good, DO, FACC, Krit Jongnarangsin, MD, Aman Chugh, MD, Hamid Ghanbari, MD, Rakesh Latchamsetty, MD, Hakan Oral, MD, FACC, Frank Pelosi, MD, FACC, Fred Morady, MD, FACC, Frank Bogun, MD, FACC Heart Rhythm Volume 12, Issue 4, Pages 706-713 (April 2015) DOI: 10.1016/j.hrthm.2014.12.017 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Delayed enhanced magnetic resonance imaging. Short axis view of the basal left ventricle of a patient with nonischemic cardiomyopathy. There is intramural delayed enhancement in the basal septum (arrows). This patient had pleomorphic premature ventricular complexes, and ablation was ineffective in this patient. Heart Rhythm 2015 12, 706-713DOI: (10.1016/j.hrthm.2014.12.017) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 A, left: Delayed enhanced magnetic resonance imaging in a patient with apical transmural scar. Long-axis view demonstrating apical scar (arrows). The site of origin of the targeted premature ventricular complex (PVC) is a transmural scar located in the left ventricular apex. The patient’s PVC was successfully ablated in the apical scar. A, right: Short-axis view close to the apex showing transmural delayed enhancement (arrows). B, left: Ultrasound image, long-axis view showing the left ventricular apex. Arrow indicates site of origin of the targeted PVC. B, middle: Activation map of the left ventricle during PVCs. The earliest site was in the left ventricular apex (arrow indicates site of origin of the mapped PVC). B, right: Left ventricular voltage map indicating an apical scar. The site of origin of the PVC is indicated by the arrow and is within the low-voltage area of the scar. The location of the mitral valve annulus (MVA) and the left ventricular apex is indicated. C: Twelve-lead ECG of the patient with couplets at the site of origin in the left ventricular apex. Activation time at the site of origin was –22 ms. Heart Rhythm 2015 12, 706-713DOI: (10.1016/j.hrthm.2014.12.017) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Left: Change of ejection fraction (EF) in patients with successful ablation. Right: Change of EF in patients with unsuccessful ablation. Heart Rhythm 2015 12, 706-713DOI: (10.1016/j.hrthm.2014.12.017) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 4 Left: Change in premature ventricular complex (PVC) burden in patients with change of ejection fraction (EF) <10%. Right: Change in PVC burden in patients with change of EF ≥10%. Heart Rhythm 2015 12, 706-713DOI: (10.1016/j.hrthm.2014.12.017) Copyright © 2015 Heart Rhythm Society Terms and Conditions