Right Ventricular Outflow Tract Ventricular Ectopics: Yet Another Tachycardia with Involvement of Autonomic Plexus?

概要

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We present a case of idiopathic ventricular tachycardia where evidence of autonomic involvement was seen during radiofrequency ablation. <B>Case Report:</B> A 32 year old man with symptomatic idiopathic VPCs underwent electrophysiologic testing. Baseline rhythm was sinus with frequent VPCs including trigeminy. The VPCs had morphology suggestive of RVOT origin. Rotational angiography with 3D reconstruction of the RVOT was done using the DynaCT (Siemens AG, Germany) superimposed over the live fluoro. An ARRAY catheter was introduced in the RVOT and the 3D electro-anatomical map was created using the Ensite Array system (St Judes Medical, USA). The VPCs were originating from a single site just below the pulmonary valve on the postero-medial wall of the RVOT. A non irrigated 4 mm tip 7F bidirectional ablation catheter (Bard, USA) was taken and the site of origin of the VPCs targeted. Pace map through the ablation catheter showed 12/12 match. During the RF pulse there was severe sinus bradycardia with almost a cardiac standstill during the initial few pulses. After the initial few RF pulses, this phenomenon disappeared along with the complete cessation of VPCs. <B>Discussion:</B> The response of the heart rate during ablation at the successful site in this case clearly points to a direct anatomical relationship to parasympathetic enervation and warrants further investigation, just as in the case of atrial fibrillation.