PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf ·...
Transcript of PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf ·...
![Page 1: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/1.jpg)
PVC originating from RCC of aortic valve
Saruul Tseveendee
Shastin Third State Hospital
![Page 2: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/2.jpg)
Patient 28 y.o/M
Brief Hx
Complain Dizziness, lightheadedness
Holter recordingsPVC 42.7% (2015-02-24), 38.6% (2016-11-16), 41.77% (2017-02-15)
Echo findings No structural heart disease, EF 57%
Medication Beta-blocker for 2 years
Clinical case
![Page 3: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/3.jpg)
ECG #2 (2017-02)
![Page 4: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/4.jpg)
ECG #1 (2015-02)
![Page 5: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/5.jpg)
Localizing PVC origin
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Ouyang F. J Am Coll Cardiol 2002;39:500
![Page 6: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/6.jpg)
Localizing PVC origin
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Kamakura et al., Circulation 1998; 98: 1525-1533
1. QRS polarity of lead I- rS pattern
2. Initial r-wave amplitude in leads V1 and V2 was
high
3. The QS wave amplitude in leads aVR and aVL was
useful. If the QS wave depth in lead aVL was larger
than that in lead aVR,
4. Lead AVL shows initial 40 ms of PVC is isoelectric
![Page 7: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/7.jpg)
Ablation catheter on LCC
Far-field potential
![Page 8: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/8.jpg)
Ablation catheter on RCC
Far-field potential
![Page 9: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/9.jpg)
Ablation catheter under the Aortic valve
![Page 10: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/10.jpg)
Ablation catheter on RCC
Sharp potential
![Page 11: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/11.jpg)
Exit site of PVC
![Page 12: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/12.jpg)
Early Potential on ablation catheter
![Page 13: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/13.jpg)
PVC location
Yamada T, et al.,Heart Rhythm 2013;10:1605–1612
![Page 14: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/14.jpg)
Anatomy of LVOT
Yamada T, et al. Heart Rhythm 2013;10:1605–1612
![Page 15: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/15.jpg)
Yamada T, et al. Heart Rhythm 2013;10:1605–1612
![Page 16: PVC originating from RCC of aortic valvek-hrs.org/KHRS/2018/pdf/38. Saruul Tseveendee.pdf · Ablation catheter on RCC Far-field potential. Ablation catheter under the Aortic valve.](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f52740971c8f4517c4e86c6/html5/thumbnails/16.jpg)
Take home message
• Carefully evaluate surface ECG, there must be all clues
• Few drugs for PVC control (1st option for LVOT/PVC)
• Ablation is difficult when PVC are not very frequent during EP study