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Europace Advance Access published online on September 27, 2006
Europace, doi:10.1093/europace/eul098
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© The European Society of Cardiology 2006. All rights reserved
Received December 22, 2005
Accepted May 5, 2006

Article

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

Massimo Mantica 1 *, Lucia De Luca 1, Rafael Fagundes 1, and Claudio Tondo 1

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

* To whom correspondence should be addressed.
Massimo Mantica, E-mail: massimo.mantica{at}grupposandonato.it


  Abstract

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.

Keywords: Catheter ablation; Chronic heart failure; Cardiac resynchronization therapy; Ventricular arrhythmias; Left ventricular tract tachycardia; Ablation via coronary sinus; Implantable cardioverter/defibrillator.
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