# Enveloped Ablation: A Strategy for Managing Outflow Tract PVCs With an R Wave Pattern Break in Lead V2

## TL;DR

A new ablation technique called 'enveloped ablation' is used to treat difficult heart rhythm issues in a patient with specific ECG patterns.

## Contribution

The novel 'enveloped ablation' technique is introduced for managing OT-PVCs with R wave pattern breaks in Lead V2.

## Key findings

- Detailed electroanatomical mapping identified the earliest activation site in a drug-resistant patient.
- Multisite, low-power ablation around the critical site successfully managed OT-PVCs with PBV2.
- The technique was tailored to the electrical and structural characteristics of the condition.

## Abstract

Outflow tract premature ventricular contractions (OT-PVCs) with an R wave pattern break in Lead V2 (PBV2) pose significant treatment challenges due to their refractory nature and complex anatomical origins. A 56-year-old male with drug-resistant palpitations underwent detailed electroanatomical mapping using a microcatheter to identify the earliest activation site. This precision mapping was crucial for directing the ablation strategy accurately. The “enveloped ablation” technique was employed, involving multisite, low-power ablations surrounding the critical activation site, tailored to address the unique electrical and structural characteristics of OT-PVCs with a PBV2. This case highlights the importance of accurate mapping and tailored ablation strategies in managing OT-PVCs with PBV2.