Anterograde and retrograde insulated pathway conduction evidenced by intracardiac electrogram morphologies during premature ventricular contractions and.

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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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Anterograde and retrograde insulated pathway conduction evidenced by intracardiac electrogram morphologies during premature ventricular contractions and sinus rhythm Seina Yagyu, MD, Koichi Nagashima, MD, PhD, Ryuta Watanabe, MD, Masaru Arai, MD, Yuji Wakamatsu, MD, Naoto Otsuka, MD, Yasuo Okumura, MD, PhD HeartRhythm Case Reports Volume 5, Issue 3, Pages 155-158 (March 2019) DOI: 10.1016/j.hrcr.2018.12.001 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Twelve-lead electrocardiogram recorded during the procedure showing sinus rhythm (SR) and a premature ventricular contraction (PVC). B, C: Pace-maps obtained from the ablation sites in the right ventricular outflow tract (RVOT) (B) and the left ventricular outflow tract (LVOT) (C). HeartRhythm Case Reports 2019 5, 155-158DOI: (10.1016/j.hrcr.2018.12.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac electrograms obtained at the right ventricular outflow tract (RVOT) (A) and left ventricular outflow tract (B) before ablation, and the left ventricular tract after successful ablation (C). D: Intracardiac echocardiogram recorded for electroanatomic assessment of the site of the successful ablation. Recording from the ablation catheter (ABL) shows the point of successful ablation was at the right coronary cusp (RCC)–left coronary cusp (LCC) commissure. Pink tag indicates the site of earliest activation in the right ventricular outflow tract. LPO = left posterior oblique; NCC = noncoronary cusp; PVC = premature ventricular contraction; SR = sinus rhythm. HeartRhythm Case Reports 2019 5, 155-158DOI: (10.1016/j.hrcr.2018.12.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Comparison of the vertically and horizontally flipped presystolic electrogram preceding the premature ventricular contraction (PVC) and electrogram showing the late potential during sinus rhythm (SR). The configurations nearly match. Bidirectional conduction of the insulated myocardial pathway is represented schematically. Ao = aorta; LVOT = left ventricular outflow tract; RVOT = right ventricular outflow tract. HeartRhythm Case Reports 2019 5, 155-158DOI: (10.1016/j.hrcr.2018.12.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions