Ventricular Ectopic Ablation

Abstract

Ventricular ectopics (VEs) also called premature ventricular contractions (PVCs) can be present in individuals with and without structural heart disease. Symptoms and prognosis vary greatly. The ECG is the cornerstone of diagnostic evaluation defining the origin as well as PVC burden. Even in structurally normal hearts PVCs can lead to PVC-induced cardiomyopathy. In structural heart disease, PVCs can aggravate left ventricular dysfunction. Indications for catheter ablation of PVCs include symptomatic PVCs, PVC-induced cardiomyopathy, malignant PVCs triggering ventricular tachyarrhythmia, reduced biventricular pacing in patients with cardiac resynchronization therapy and asymptomatic patients with a high PVC burden. Established mapping strategies are the “local earliest activation”, the unipolar electrogram, pace-mapping and 3D electroanatomical mapping systems. This chapter describes algorithms for identifying the PVC origin on an ECG, mapping strategies, and localization in structurally normal hearts and structural heart disease.