Radiofrequency ablation of idiopathic ventricular arrhythmia originating from the tricuspid annulus

Abstract

A 20-year-old female patient was referred to our division for drug-resistant symptomatic ventricular extra-stimuli and short salvos of ventricular tachycardia. No underlying structural heart disease or detectable channelopathy was found during diagnostic tests. Her preprocedural electrocardiogram (Fig. 1, left panel) showed ‘notch’ in the limb leads, the precordial R-wave transition in leads V4 to V5, and increased Q-wave amplitude in each of leads V1 to V3, all suggesting the arrhythmia focus from the free wall of the tricuspid annulus (TA). During electrophysiologic study under the guidance of 3-dimensional electroanatomic mapping using the Carto 3 system (The Carto 3 System, Biosense Webster, Belgium) earliest local activation times during the arrhythmia were obtained from the anterolateral free wall of the TA (Fig. 2). Activation mapping also demonstrated the arrhythmia focus and its propagation to the other sites of the right ventricle (Movie). Initial radiofrequency ablation attempts using irrigated tip ablation catheter (Navistar® Thermocool®, Biosense Webster, Belgium) to this region stopped the arrhythmia abruptly. Then applying multiple lesions in close proximity to the initial site diminished the idiopathic arrhythmia completely (Fig. 2). Postprocedural electrocardiogram showed no residual arrhythmia with a regular sinus rhythm (Fig. 1, right panel).