Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow.

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Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow tract in a patient with early repolarization syndrome Jun Kakihara, MD, Masahiko Takagi, MD, PhD, FHRS, Yusuke Hayashi, MD, Hiroaki Tatsumi, MD, PhD, Atsushi Doi, MD, PhD, Minoru Yoshiyama, MD, PhD HeartRhythm Case Reports Volume 2, Issue 4, Pages 342-346 (July 2016) DOI: 10.1016/j.hrcr.2016.04.001 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: The12-lead electrocardiogram (ECG) on admission. The J wave observed in lead I shows slurring, while those in V4 to V6 show notching (black arrows). The maximum J-point amplitude is 0.8 mV in lead V4. B: Spontaneous clinical premature ventricular contraction (PVC) with left bundle branch block morphology and inferior axis during hospitalization. C: An ambulatory monitoring ECG in lead II shows monomorphic PVC and ventricular bigeminy (asterisk). A PVC with the same morphology induced ventricular fibrillation. HeartRhythm Case Reports 2016 2, 342-346DOI: (10.1016/j.hrcr.2016.04.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Daily J-wave fluctuations (black arrows) during hospitalization: A: on admission; B: on day 9 of hospitalization; C: on day 16 of hospitalization; D: at 1 month of hospitalization. 12-ECG on admission showed more prominent J waves in lateral leads, but J waves disappeared on day 9, and reappeared on day 16 and increased amplitude at 1 month of hospitalization. HeartRhythm Case Reports 2016 2, 342-346DOI: (10.1016/j.hrcr.2016.04.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: The12-lead electrocardiograms (ECGs) of spontaneous clinical PVC1 (left panel) and paced beat (middle panel) and successful ablation site under fluoroscopy (right panel; white arrow) at the posterolateral site of the right ventricular outflow tract (RVOT). B: The12-lead ECGs of spontaneous clinical PVC2 (left panel) and paced beat (middle panel) and successful ablation site under fluoroscopy (right panel; white arrow) at the posterior attachment of the RVOT. RAO = right anterior oblique image; LAO = left anterior oblique image; His = His-bundle catheter. HeartRhythm Case Reports 2016 2, 342-346DOI: (10.1016/j.hrcr.2016.04.001) Copyright © 2016 Heart Rhythm Society Terms and Conditions