The heart is comprised of 4 chambers; 2 atria, which sit on 2 ventricles. An electrical “timekeeper”, called the sino-atrial node, is located at the top of the right atrium. This is the heart’s natural pacemaker, sending out regular electrical impulses that travel through pathways which run down the atria, through the ‘junction box’ of the heart (known as the AV node) and into the ventricles, allowing the heart to contract and relax regularly and pump blood around the body.
Ventricular Ectopy (VE) occurs when electrical stimuli are initiated from within the ventricles. An extra focus outside the normal conduction tissue is often the focus of these extra ectopies. There are different types of VEctopy site of origin – some are seen in patients with a completely normal heart and are not life threatening, but some are seen in patients with other forms of heart disease and these can be very serious and even fatal. Symptoms can include palpitations, dizziness, breathlessness; in some instances, also chest pain and blackouts.
Investigation of VEctopy includes initially taking a simple ECG. Sometimes ambulatory ECG monitoring is needed alongside an exercise stress provocative test followed by more technical EP studies to identify the site of origin of the electrical impulses. Treatment can be with medication. However, some patients may also benefit from catheter ablation.
Below are examples of Left Outflow Tract Ventricular Ectopy Ablation arising from the AnteroLateral Papillary Muscle (ALPM) and Poster-Medial Papillary Muscle (PMPM) performed in patients with a structurally normal heart, high ventricular ectopy burden intruding daily activity of living.