Figure 1.
(A) 12-lead morphology of the clinical premature ventricular contraction (PVC) showing the right bundle left inferior axis. (B) Fluoroscopic views of the mapping catheter in the first septal perforator branch. (C) Earliest activation in the septal catheter preceding the PVC QRS onset by 54 ms. (D) Activation map showing earliest activation within the septal venous perforator (white). (E) Ablation lesions (black) placed anatomically proximal to the earliest activation with successful elimination of the premature ventricular contraction
Figure 2.
(A) Cardiac magnetic resonance imaging showing midmyocardial delayed enhancement. (B) Left anterior oblique view of selective coronary venogram of the first septal perforator, and right anterior oblique view of a multipolar catheter in the septal perforator. (C) Activation during ventricular tachycardia showing earliest activation within the septum (red arrow), compared with the left ventricular (LV) endocardium (blue arrow) and LV epicardium (green arrow). (D) Final ablation lesion set following sequential unipolar ablation of the septum from the right and left ventricles.
Figure 3.
Fluoroscopic views of ablation catheter for bipolar ablation targeting different anatomical substrates. (A) Ablation catheters in the left ventricular (LV) endocardium and epicardium. (B) Ablation catheters in the LV endocardium and middle cardiac vein. (C) Ablation catheters between the pulmonic cusp and left coronary cusp to target LV summit.