Discrete prepotentials with an isoelectric segment at the successful ablation site in the right ventricular outflow tract and pulmonary artery junction.

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Discrete prepotentials with an isoelectric segment at the successful ablation site in the right ventricular outflow tract and pulmonary artery junction in a case with a ventricular arrhythmia Shinsuke Miyazaki, MD, Hitoshi Hachiya, MD, Junji Matsuda, MD, Takamitsu Takagi, MD, Tomonori Watanabe, MD, Yoshito Iesaka, MD, FHRS HeartRhythm Case Reports Volume 1, Issue 5, Pages 348-351 (September 2015) DOI: 10.1016/j.hrcr.2015.06.005 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Activation and pace mapping and fluoroscopic images of the catheter position at the left coronary cusp adjacent to the ostium of the left coronary artery. The earliest activation preceded the QRS onset by 24 milliseconds, and nearly perfect pace mapping (11/12) was obtained. ABL = mapping catheter; RVA = right ventricular apex; uni = unipolar; bi = bipolar; RAO = right anterior oblique view; LAO = left anterior oblique view. HeartRhythm Case Reports 2015 1, 348-351DOI: (10.1016/j.hrcr.2015.06.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Activation and pace mapping and fluoroscopic images of the catheter position at the successful ablation site at the right ventricular outflow tract-PA junction. The discrete prepotential preceded the QRS onset by 110 milliseconds, with a 63-millisecond isoelectric segment. Pace mapping with a stimulus–QRS interval of 48 milliseconds was excellent when pacing was delivered at the same site at which the discrete prepotential was recorded. HeartRhythm Case Reports 2015 1, 348-351DOI: (10.1016/j.hrcr.2015.06.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 A: The discrete prepotential constantly preceded the QRS onset of the PVCs at the successful ablation site at the right ventricular outflow tract–pulmonary artery junction. B: After a 5.3-second radiofrequency (RF) application at that site, the ventricular arrhythmias were no longer observed. C: The fractionated potentials fused with the QRS complex during the sinus beats prior to the application disappeared just after the successful application. HeartRhythm Case Reports 2015 1, 348-351DOI: (10.1016/j.hrcr.2015.06.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions