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A 50-year-old man was referred for radiofrequency catheter ablation of idiopathic premature ventricular contraction (PVC) refractory to metoprolol. The ECG characteristics of the PVCs suggested that the PVCs originated from left coronary sinus (LCC). Mapping was performed in the LCC using a 7F irrigated-tip ablation catheter via the right femoral artery. During clinical PVCs, the local ventricular activation was the earliest at the LCC. Radiofrequency (RF) energy application was attempted at the site (Figure [A1] and [B1]). Coronary angiography was performed before RF application, revealing a normal left coronary artery without stenosis. The distance from the catheter tip to the left main coronary artery (LMCA) ostium was ≈10 mm by fluoroscopy (Figure [A2] and [B2]). One application of RF energy at this site (43°C, 30 W, 17 mL/min) terminated spontaneous PVCs within 15 s and was maintained for 180 s. However, the clinical PVCs appeared during isoproterenol infusion. Another 3 applications around this point with a maximal setting of 40 W were 180 s in duration and finally eliminated the PVCs. Mean impedance drop was 12±2 Ω for the lesions. Popping or impedance rises did not occur during RF applications. No catheter dislodgment was observed during ablation, and ablation was performed only within the LCC. The patient experienced some chest …

circulation. arrhythmia and electrophysiology

Chronic Left Coronary Artery Stenosis After Radiofrequency Ablation of Idiopathic Premature Ventricular Contraction Originating From Left Coronary Sinus Cusp