RESUMEN
BACKGROUND: When the coupling interval is matched, ventricular parasystole can form a stable fusion QRS complex with sinus rhythm. Ablation of a fusion QRS complex has been rarely reported and is unexpectedly difficult. CASE PRESENTATION: We describe a case of ventricular parasystole from muscle sleeves of the right ventricular outflow tract. The patient was a 54-year-old woman who was admitted to the hospital because of frequent palpitations for 3 months. Anti-arrhythmic drugs had been ineffective, and she had no history of cardiovascular disease. Because the fusion QRS complex interfered with the conventional mapping technique, we could not eliminate the ventricular parasystole successfully. RESULTS AND CONCLUSIONS: Finally, we used the reversed U curve method and found that the source of ventricular arrhythmia was in the right cusp according to the special local potential. A fusion QRS complex formed by ventricular parasystole and nodal ventricular activation make mapping and ablation difficult. The special local potential was the only evidence available to confirm the target of ablation satisfactorily.
Asunto(s)
Ablación por Catéter , Ventrículos Cardíacos/cirugía , Parasístole/cirugía , Complejos Prematuros Ventriculares/cirugía , Potenciales de Acción , Técnicas Electrofisiológicas Cardíacas , Femenino , Frecuencia Cardíaca , Ventrículos Cardíacos/fisiopatología , Humanos , Persona de Mediana Edad , Parasístole/diagnóstico , Parasístole/fisiopatología , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/fisiopatologíaRESUMEN
A 76-year-old man with a history of atrial septal defect repair underwent radiofrequency (RF) ablation of typical atrial flutter. During electrophysiological study, incessant sharp potentials were recorded, originating from the ostium of the inferior vena cava (IVC), and dissociated from atrial activity. During sinus rhythm, these potentials propagated to the atria and caused premature complexes when falling beyond the atrial refractory period. Electro-anatomical mapping revealed the presence of the earliest potential in the postero-lateral ostium of the IVC, propagating to the septal region. After RF isolation of the IVC, the patient has remained arrhythmia-free over a 5-year follow-up.
Asunto(s)
Aleteo Atrial/complicaciones , Aleteo Atrial/cirugía , Ablación por Catéter/métodos , Sistema de Conducción Cardíaco/cirugía , Parasístole/complicaciones , Parasístole/cirugía , Vena Cava Inferior/cirugía , Anciano , Mapeo del Potencial de Superficie Corporal , Humanos , Masculino , Parasístole/diagnóstico , Resultado del TratamientoAsunto(s)
Bloqueo de Rama/fisiopatología , Parasístole/fisiopatología , Taquicardia Ventricular/fisiopatología , Adulto , Bloqueo de Rama/cirugía , Ablación por Catéter , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Humanos , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/cirugía , Masculino , Parasístole/cirugía , Taquicardia Ventricular/cirugíaRESUMEN
In two patients, ventricular parasystole (VP) was associated with ventricular tachycardia (VT), and in one patient, catheter ablation was successful. In patient 1, with dilated cardiomyopathy, VP led to VT, which converted to ventricular fibrillation. In patient 2, VP led to symptomatic nonsustained polymorphic VT. The origin of parasystolic focus was determined by endocardial mapping, and a radiofrequency current was delivered to patient 2. Both VP and VT disappeared immediately, and no recurrence has been observed during a follow-up of 8 months. Catheter ablation to the parasystolic focus was effective and a relationship between VP and VT was strongly suggested.