A new mapping and ablation strategy for premature ventricular complexes originating from the proximal left anterior fascicle under the guidance of electrocardiographic characteristics.

BACKGROUND

Premature ventricular complexes (PVCs) originating from the proximal left anterior fascicle (LAF) can be eliminated safely from the right coronary cusp (RCC).

OBJECTIVE

This study was performed to evaluate a new mapping and ablation strategy for proximal LAF-PVCs under the guidance of electrocardiographic characteristics.

METHODS

Proximal LAF-PVCs were defined as PVC-QRS with prominent inferior frontal plane QRS axis, right bundle branch block pattern, and with QRS duration difference (between PVC and sinus rhythm) <15 ms. The study group consisted of consecutive patients with proximal LAF-PVCs, which were prospectively mapped and ablated from only the RCC. The control group consisted of patients with proximal LAF-PVCs, which were mapped from the left ventricle and RCC before ablation from within the RCC was successful.

RESULTS

There were 24 and 8 patients in the study and control groups, respectively. For the study group, after mapping from only the RCC, proximal LAF-PVCs were eliminated with ablation from the RCC alone (2.5 ± 0.7 lesions). Mapping time (9.3 ± 5.8 min vs 27.9 ± 6.8 min, P < .001), and procedure time (43.8 ± 7.5 min vs 61.0 ± 6.9 min, P < .001) of the study group were shorter than that of the control group. Long-term success rates and electrocardiographic characteristics were similar between groups.

CONCLUSION

Under the guidance of electrocardiographic characteristics, this new mapping and ablation strategy (from the RCC alone) is a simple, safe, and effective method for elimination of proximal LAF-PVCs.