Case 6

Abstract

A 66-year-old male patient with a history of dilated cardiomyopathy with mild LV systolic dysfunction (LVEF of 46%) and ventricular arrhythmia (PVCs with a high ventricular arrhythmia burden at 24-h Holter ECG: 38,613 isolated PVC, couplets, and short runs, representing 37% of the total QRS complexes/24 h) was admitted to the cardiology department complaining of aggravated palpitations during the past few days. His cardiovascular risk factors were represented by age > 55 years old, arterial hypertension, dyslipidemia, and overweight. His medication at home consisted of ramipril 10 mg, metoprolol 200 mg, aspirin 75 mg, and atorvastatin 40 mg. For the treatment of his ventricular arrhythmia, flecainide and propafenone were tried but failed to reduce his symptoms, and amiodarone was refused by the patient due to potential side effects.

His ECG showed sinus rhythm with a heart rate of 60 bpm, QRS axis at −90°, LAFB, RBBB, isolated monomorphic PVC.

Transthoracic echocardiography showed a mildly dilated LV with mild systolic ventricular dysfunction, EF of 46%. It also showed type 1 diastolic dysfunction, absence of significant valve disease, a mildly dilated left atrium, a non-dilated right ventricle, a non-dilated right atrium, mild pulmonary hypertension, sPAP of 37 mmHg, a non-dilated IVC, and absence of pericardial effusion.

A radiofrequency catheter ablation procedure was offered and subsequently performed. The present case illustrates a catheter ablation procedure of PVCs originating from the junction of the left and right coronary cusps in a patient with ischemic heart disease.