Cryoablation of ventricular arrhythmias originating from septal aspects of mitral and tricuspid annulus

Two cases of frequent ventricular ectopy are described. Case one: a 49 year-old woman with post myocarditis extrasytoles (34 000/24 h). The ectopic focus was located on the tricuspid annulus - directly in the area of largest and sharpest His bundle potential and where direct His bundle capture was observed during all pace mapping attempts. Case two: a 15 year- -old men with idiopathic, very frequent premature ventricular beats from septal aspect of the mitral annulus. The area of earliest activation during the spontaneous ectopy with 12/12 pace map match showed obvious His bundle potential, moreover, the radiofrequency ablation catheter was unstable in that position (inferoseptal from retrograde aortic approach). In both cases treatment with cryoablation was successfully and uneventful. In conclusion, cryoablation instead of radiofrequency current ablation should be used for ventricular ectopy from septal part of the tricuspid or mitral annuli especially in cases of parahisian localisation and/or catheter instability.