Left ventricular pseudoaneurysm as a complication of left ventricular summit premature ventricular contraction ablation Sanjay Dandamudi, MD, Susan S.

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Presentation transcript:

Left ventricular pseudoaneurysm as a complication of left ventricular summit premature ventricular contraction ablation Sanjay Dandamudi, MD, Susan S. Kim, MD, Nishant Verma, MD, MPH, S. Chris Malaisrie, MD, Roderick Tung, MD, Bradley P. Knight, MD, FHRS HeartRhythm Case Reports Volume 3, Issue 5, Pages 268-271 (May 2017) DOI: 10.1016/j.hrcr.2017.01.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Top section shows 3-lead electrocardiogram (ECG) and intracardiac electrograms from the ablation catheter positioned in the left coronary cusp. The intracardiac electrograms from the ablation catheter during the premature ventricular contraction (PVC) demonstrates a far-field signal approximately 20 ms pre–surface QRS (red arrow). Bottom section shows 12-lead ECG and intracardiac electrograms from the ablation catheter positioned in the left coronary cusp, showing immediate PVC suppression after initiation of radiofrequency energy. HeartRhythm Case Reports 2017 3, 268-271DOI: (10.1016/j.hrcr.2017.01.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Cardiac magnetic resonance imaging, sagittal view of the left ventricle, left ventricular outflow tract, aortic valve, and aortic annulus. There is a 2.4 × 2.4-cm outpouching arising from the basal anterior left ventricular wall immediately below the aortic valve consistent with a left ventricular pseudoaneurysm (red arrow). Adjacent subendocardial delayed enhancement in the basal anterior left ventricular wall was seen on additional delayed enhancement sequences (not pictured) and likely related to radiofrequency ablation. HeartRhythm Case Reports 2017 3, 268-271DOI: (10.1016/j.hrcr.2017.01.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 A: A chest computed tomography (CT) 3D reconstruction, anterior view. A pseudoaneurysm (red arrow) is seen arising from the left ventricular summit, below the left anterior descending coronary artery, and extending over the base of the left ventricle. The left atrial appendage (blue arrow) and left superior pulmonary vein (white arrow) can be seen above the pseudoaneurysm. Initially, the ventricular pseudoaneurysm was misinterpreted as the left atrial appendage. B: Chest CT 3D reconstruction, posterolateral view. The pseudoaneurysm (red arrow) is seen protruding from the basal left ventricle, inferior to the left atrial appendage (blue arrow) and left superior pulmonary vein (white arrow). A posteriorly inserted pericardial drain (green arrow) can also be seen. LA = left anterior. HeartRhythm Case Reports 2017 3, 268-271DOI: (10.1016/j.hrcr.2017.01.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions