Tanaka Atsushi, Nozoe Masatsugu, Tsutsumi Takaki, Kubota Toru
Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-ku, Fukuoka 810-0001, Japan.
Eur Heart J Case Rep. 2022 Mar 22;6(4):ytac129. doi: 10.1093/ehjcr/ytac129. eCollection 2022 Apr.
Ventricular premature complexes (VPCs) occasionally originate from the aortic sinus of Valsalva. Because the anterior part of the left coronary cusp (LCC) and right coronary cusp (RCC) are connected through the ventricular musculature at their bases, VPCs are more common in the LCC and the RCC than in the non-coronary cusp (NCC). We herein report a case in which VPCs were successfully ablated from the NCC, which is considered rare.
A 30-year-old woman was admitted to our hospital for the ablation of VPCs, which comprised 43% of the total heart beats. The clinical VPCs had an inferior axis and left bundle branch block morphology with a precordial transition between V4 and V5. Three-dimensional mapping of the target VPCs indicated that the earliest activation site was RCC. After radiofrequency (RF) energy application at the RCC, VPCs were temporally suppressed but recurred after 24 min. Remapping of the recurrent VPCs revealed that the earliest activation site shifted from the RCC to the His region. To avoid the risk of atrioventricular block, RF energy was applied from the NCC, which resulted in successful elimination of the VPCs without any complications.
The present case suggests that RF energy application from the NCC may be a safe and effective option for the ablation of VPCs with the earliest activation at the RCC and His region.
室性早搏（VPCs）偶尔起源于主动脉瓣窦。由于左冠状动脉瓣叶（LCC）和右冠状动脉瓣叶（RCC）的前部在其基部通过心室肌相连，因此VPCs在LCC和RCC中比在无冠状动脉瓣叶（NCC）中更常见。我们在此报告一例成功从NCC消融VPCs的病例，这被认为是罕见的。
一名30岁女性因消融占总心跳43%的VPCs入住我院。临床VPCs呈下轴和左束支传导阻滞形态，胸前导联在V4和V5之间过渡。对目标VPCs进行三维标测显示最早激动部位为RCC。在RCC施加射频（RF）能量后，VPCs暂时受到抑制，但24分钟后复发。对复发的VPCs重新标测显示最早激动部位从RCC转移到希氏区。为避免房室传导阻滞风险，从NCC施加RF能量，成功消除了VPCs，且无任何并发症。
本病例提示，对于最早激动位于RCC和希氏区的VPCs，从NCC施加RF能量可能是一种安全有效的消融选择。
