Transient Elimination of Posterior Right Ventricular Outflow Tract Ectopy by Sternal Pressure

Abstract

Ventricular ectopy (VE) originating in the right ventricular outflow tract (RVOT) is a common arrhythmia. Mechanisms triggering or eliminating VE from RVOT are not entirely understood. A patient with frequent, symptomatic VE underwent an electrophysiologic study: VE origin was mapped by NavX 3D navigation (St. Jude Medical, Inc., St. Paul, MN, USA). Incidental pressure applied manually to the sternum reproducibly eliminated VE for the time of exposure. Radiofrequency-ablation was successfully performed in the posterior RVOT. The mechanism resulting in VE suppression remains speculative, since a mechanical alteration of the substrate for VE in the posterior RVOT by sternal pressure seems unlikely. "Mechano-electrical feedback" might have been the mechanism operative in this case.