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Europace Advance Access originally published online on September 27, 2006
Europace 2006 8(11):980-983; doi:10.1093/europace/eul098
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Transcatheter ablation through the cardiac veins in a patient with a biventricular device and left ventricular epicardial arrhythmias

Massimo Mantica*, Lucia De Luca, Rafael Fagundes and Claudio Tondo

Cardiac Arrhythmia Center and Electrophysiology Laboratory, St Ambrogio's Clinical Institute, University of Milan, Via Faravelli 16, Milan 20149, Italy

Left ventricular outflow tract (LVOT) may be a source of repeated premature ventricular complexes (PVCs). In symptomatic patients, radiofrequency catheter ablation (RFCA) can be effective, either from endocardial or from epicardial sites.

A 50-year-old patient, with dilated cardiomyopathy (DCM) and severe left ventricular (LV) dysfunction, left bundle branch block (LBBB), New York Heart Association (NYHA) class IV, received a biventricular implantable cardioverter/defibrillator (ICD) in 2002. Despite drug therapy, PVCs were frequent (21.019/24 h) including prolonged runs, prompting ICD intervention. Premature ventricular complexes showed an inferior axis morphology, with an R/S ratio in V3>1, suggesting an LVOT origin. Despite the cardiac resynchronization therapy (CRT) device, successful RFCA was performed through the anterior venous branch, with a favourable clinical outcome.

To our knowledge, this is the first case describing epicardial RFCA of a PVC focus from cardiac veins in the presence of a CRT device.

Key Words: Catheter ablation, Chronic heart failure, Cardiac resynchronization therapy, Ventricular arrhythmias, Left ventricular tract tachycardia, Ablation via coronary sinus, Implantable cardioverter/defibrillator

* Corresponding author. Tel: +39 02 33127712 ext. 7713; fax: +39 02 33127038. E-mail address: massimo.mantica{at}grupposandonato.it


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