[Fulguration of extrasystolic ventricular focus]

Area of Science:

• Cardiology
• Electrophysiology
• Medical Case Reports

Background:

• Symptomatic premature ventricular contractions (PVCs) can be challenging to manage, especially when refractory to antiarrhythmic drug therapy.
• Right bundle branch block (R3RBBB) QRS morphology with left axis deviation (LAD) can indicate specific ventricular origins for arrhythmias.
• Identifying the precise focus of PVCs is crucial for effective targeted treatment strategies.

Observation:

• A 68-year-old female presented with symptomatic PVCs unresponsive to medication.
• Her electrocardiogram (ECG) showed a distinct pattern of RBBB morphology and LAD.
• No underlying structural heart disease was detected.

Findings:

• Endocardial mapping precisely located the PVC focus to the meso-inferoapical region of the left ventricular septum.
• The origin was suggested to be within the Purkinje network of the left posterior fascicle.
• Catheter ablation using direct-current energy successfully eliminated the PVCs without any complications.

Implications:

• Catheter ablation is a viable and effective treatment for drug-refractory PVCs originating from the left posterior fascicle.
• This case highlights the importance of detailed electrophysiological mapping for complex ventricular arrhythmias.
• Successful ablation provides a long-term solution, improving patient quality of life and reducing healthcare burden.