Catheter ablation of premature ventricular complexes arising from the left fascicular system

Objective The present study aimed to investigate the electrophysiologic characteristics and the ablation strategy for idiopathic premature ventricular complexes (PVC) originating from the left fascicular system. Methods Of 648 patients with idiopathic PVC in the Department of Cardiology of Wuhan Asia Heart Hospital from May 2015 to August 2017, 27[18 males and 9 females, age (42.6±7.4) years, age range 21~58 years] originated from the left fascicular system enrolled in this study. All the PVC presented with a relatively narrow QRS and right bundle branch block (RBBB) morphology. Radiofrequency catheter ablation (RFCA) was applied at the earliest measured fascicular potential (FP) . Results In 27 cases, which of the average QRS duration was (117.4±8.6) ms, mapping ablation confirmed that 15 cases originated from the left anterior fascicle (LAF) , 7 from the left posterior fascicle (LPF) , 2 from the left medial fascicle (LMF) , and 3 from the common trunk of left bundle branch (LBB) . The earliest FP was mapped ahead of the body surface QRS complex by (32.7±6.4) ms. The immediate ablation success rate was 100%. Three patients had recurrent PVC during follow-up. The total success rate from a single center was 88.9%. Conclusion Ablation of PVC originating from the left fascicular system guided by an earliest presystolic FP was safe and effective. Key words: Catheter ablation; Premature ventricular complexes; Left fascicular system