Narrow QRS ectopy with concealed connections from a para-Hisian origin to the proximal left fascicles
Kohki Nakamura1, Takehito Sasaki1, Kentaro Minami2
1Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan.
Insights
Catheter ablation for narrow QRS ectopy near the His bundle is challenging. Successful radiofrequency ablation was achieved using ultrahigh-resolution mapping, identifying a para-Hisian origin.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmia Management
- Interventional Cardiology
Background:
- Catheter ablation targeting ectopy near the His bundle presents significant challenges due to the critical anatomical structures involved.
- Understanding the precise origin of arrhythmias is crucial for successful ablation outcomes.
Observation:
- A case is presented of a 33-year-old male with narrow QRS ectopy exhibiting preferential conduction to the proximal left fascicles.
- The ectopy was found to originate from a para-Hisian location, adjacent to the His bundle.
Findings:
- Ultrahigh-resolution mapping of the His bundle, bundle branch, and fascicular electrograms guided the procedure.
- Successful radiofrequency ablation was performed in the right coronary cusp, eliminating the ectopy.
Implications:
- This case suggests that some narrow QRS ectopy may arise from structures near, but not within, the "true" cardiac conduction system.
- Concealed connections between these para-Hisian origins and the conduction system can exist and be successfully targeted.
- Advanced mapping techniques are vital for complex cases of para-Hisian ectopy.
Introduction:
Catheter ablation of ectopy originating from the vicinity of the His bundle can be challenging.
Methods And Results:
We report a case of a 33-year-old man with narrow QRS ectopy with preferential conduction from a para-Hisian origin to the proximal left fascicles, which was successfully eliminated by radiofrequency ablation in the right coronary cusp, guided by ultrahigh-resolution mapping of the His bundle, bundle branch, and fascicular electrograms.
Conclusion:
Some narrow QRS ectopy may originate from the vicinity of the conduction system, instead of the "true" conduction system, and have concealed connections from its origin to the conduction system.
More Related Videos
06:57Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
Published on: January 31, 2019
09:17High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
Related Concept Videos
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
01:19Electrophysiology of Normal Cardiac Rhythm
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:16ECG Interpretation of Arrhythmias I: Sinus Arrhythmias
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism,...