A Case of PVC Originating from Just above the Tricuspid Valve
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概要
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A 65-year-old male had been detected PVC previously, and he was referred to our hospital because of the increase in the PVC, and catheter ablation was performed. The PVC showed R wave transition between V3 and V4, large R wave in lead I, and large negative R in aVR, and they were accorded with that of right ventricular outflow tract (RVOT). On the other hand, small R wave in lead II and aVF, and negative R wave in lead aVL indicated the origin other than RVOT. Three-dimensional mapping with noncontact array showed the earliest activation site at the inferior-septum of the tricuspid valve. Although pacemap was not perfect in this site, QS pattern was observed in the unipolar electrogram, and local potential preceded clinical PVC by 20 msec. Ablation catheter showed both large atrial and ventricular electrogram. Atria/Ventricular ratio (AV ratio) was 0.8 in the distal site of the ablation catheter, however, AV ratio was 6.6 in the proximal site, and this finding indicated that ablation catheter was positioned in just above the tricuspid valve. Application in this site terminated the PVC. In all of the PVC, tricuspid valve origin is calculated as 8% in the literature. We experienced a case of PVC successfully treated by the application just over the tricuspid valve.
著者
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HIRAO Kenzo
Heart Rhythm Center, Tokyo Medical and Dental University
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Hachiya Hitoshi
Heart Rhythm Center, Tokyo Medical and Dental University
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Sekigawa Masahiro
National Hospital Organization Disaster Medical Center
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Hayashi Tatsuya
National Hospital Organization Disaster Medical Center
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Yokoyama Yasuhiro
National Hospital Organization Disaster Medical Center
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