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Elimination of Ventricular Arrhythmia in Catecholaminergic Polymorphic Ventricular Tachycardia by Targeting “Catecholamine‐Sensitive Area”: A Dominant‐Subordinate Relationship between Origin Sites of Bidirectional Ventricular Premature Contractions |
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| Authors: | YASUHIRO SHIRAI M.D. MASAHIKO GOYA M.D. SEIKO OHNO M.D. MINORU HORIE M.D. SHOZABURO DOI M.D. MITSUAKI ISOBE M.D. KENZO HIRAO M.D. |
| Affiliation: | 1. Heart Rhythm Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan;2. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan;3. Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan;4. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan |
| Abstract: | We report on a patient diagnosed with catechoaminergic polymorphic ventricular tachycardia (CPVT) who underwent catheter ablation of ventricular premature contractions (VPCs) induced by epinephrine. VPCs were classified roughly into three types. Type 1 and Type 2 VPCs (right bundle branch block [RBBB] configuration and inferior axis) were eliminated by radiofrequency applications at the left aortic sinus of Valsalva and the anterolateral papillary muscle (APM), respectively. Although no spontaneous VPCs were seen after the elimination of Type 1 and 2 VPCs, pacing resulting in capture at the APM induced Type 3 VPC (RBBB configuration and superior axis) reproducibly. The electrophysiological findings observed in our representative case have important implications both for understanding the pathophysiology of CPVT and for considering therapeutic strategies. |
| Keywords: | catecholaminergic polymorphic ventricular tachycardia bidirectional ventricular premature contraction catheter ablation |