JACC. Case reports · 2025
Radiofrequency Catheter Ablation of Polymorphic Premature Ventricular Contractions: Originating From the His Bundle Trunk?
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Zhao Lu, Lin Yi-Xiang, Liang Xue-Cun, Liu Fang, Zhao Qu-Ming
Аннотация
BACKGROUND: Premature ventricular contractions (PVCs) truly arising from the His bundle trunk have not been documented. We report polymorphic narrow-QRS PVCs whose local Purkinje-ventricular interval (PV) interval matched the maximal His-ventricular interval (HV) in sinus rhythm yet were ablatable.
CASE SUMMARY: An 11-year-old boy (PVC burden: ∼25%) had normal imaging and laboratory results. Electrophysiology showed PV = HV during PVCs, implicating tissue adjacent to the proximal His. Reverse C-loop ablation at the high septal tricuspid annulus immediately eliminated PVCs with intact atrioventricular conduction.
DISCUSSION: Morphologically diverse PVCs shared a common focus near the proximal His. During PVCs, PV = HV supported a His-Purkinje substrate. Precise activation mapping with cautious, titrated energy enabled safe success.
TAKE-HOME MESSAGES: The earliest PVC potentials coincided with both left- and right-sided His recordings, mimicking a true His-trunk origin. The arrhythmia most likely arose from fasciculoventricular fibers-direct His-septal connections-providing a discrete, safely ablatable target.
CASE SUMMARY: An 11-year-old boy (PVC burden: ∼25%) had normal imaging and laboratory results. Electrophysiology showed PV = HV during PVCs, implicating tissue adjacent to the proximal His. Reverse C-loop ablation at the high septal tricuspid annulus immediately eliminated PVCs with intact atrioventricular conduction.
DISCUSSION: Morphologically diverse PVCs shared a common focus near the proximal His. During PVCs, PV = HV supported a His-Purkinje substrate. Precise activation mapping with cautious, titrated energy enabled safe success.
TAKE-HOME MESSAGES: The earliest PVC potentials coincided with both left- and right-sided His recordings, mimicking a true His-trunk origin. The arrhythmia most likely arose from fasciculoventricular fibers-direct His-septal connections-providing a discrete, safely ablatable target.