Catheter ablation of premature ventricular contractions originating from aortic sinus cusps in a patient with dextrocardia and situs solitus

BACKGROUND Premature ventricular contractions (PVCs) originating from aortic sinus cusps is not infrequent and can be eliminated effectively by radiofrequency ablation with rare complications. However, after a review of the medical literature, and to our knowledge, this is the first case of successful idiopathic aortic sinus cusps-PVC-ablation using a 3-dimensional (3D) mapping system in an adult with dextrocardia. METHODS A 62-year-old male with dextrocardia and situs inversus underwent catheter ablation of frequent PVCs. The electrocardiograms (ECG) were recorded by placement of the electrodes in reversed positions. The PVCs exhibited left bundle branch block and inferior axis QRS morphology with transition at leads V2-V3. The activation mapping indicated the earliest site of ventricular activation between the left and right aortic sinus cusps, highlighting that catheter ablation was successful at this point. RESULTS The catheter ablation was successful between the left and right aortic sinus cusps, and the PVCs were not detected for the subsequent 30 min following the procedure as well as for the rest of the hospital stay. CONCLUSION Combined with ECG electrodes in reversed positions and 3D electroanatomical mapping system, catheter ablation of PVCs originating from aortic sinus cusps in patients with dextrocardia can be safely and effectively performed.