Transcoronary ethanol for incessant epicardial ventricular tachycardia

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Transcoronary ethanol for incessant epicardial ventricular tachycardia Vincent Gabus, MD, Xavier Jeanrenaud, MD, Eric Eeckhout, MD, Etienne Pruvot, MD Heart Rhythm Volume 11, Issue 1, Pages 143-145 (January 2014) DOI: 10.1016/j.hrthm.2013.09.058 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 A: Twelve-lead electrocardiogram of nonsustained ventricular tachycardia (NSVT). The vertical axis of the premature beat in the peripheral leads and the progression of the R wave in chest leads during NSVT are suggestive of a high septal or anterior exit. Note the underlying biventricular stimulation. B: Electroanatomical bipolar voltage maps of the endocardial left ventricle. Superior (left) and posterosuperior (right) views are shown. An area of polyphasic signals of reduced potential is observed in the anterobasal segment (white arrows), lateral to the left ventricular outflow tract (LVOT). A fragmented signal is recorded (white cross and dotted arrow). MA = mitral annulus. Heart Rhythm 2014 11, 143-145DOI: (10.1016/j.hrthm.2013.09.058) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Cardiac resynchronization therapy-defibrillator interrogation. A: Before transcoronary ethanol ablation (TCEA) more than 7000 episodes of nonsustained ventricular tachycardia (NSVT) were recorded (red arrow) over a 3-month period. B: Six weeks after TCEA, no NSVT was recorded as highlighted by the red arrow. VF = Ventricular fibrillation, FVT = Fast ventricular tachycardia, VT = Ventricular tachycardia, AT = Atrial tachycardia, AF = Atrial fibrillation, NS = Non-sustained, SVT = Supra-ventricular tachycardia, Rx = Treatement, V = Ventricular Heart Rhythm 2014 11, 143-145DOI: (10.1016/j.hrthm.2013.09.058) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 3 A: Cardiac magnetic resonance imaging short-axis view showing a large antero-latero-basal scar visible as a light gray area of late enhancement highlighted by a dotted line. Note the presence of viable epicardial myocardium adjacent to the scar (white arrows). The solid line highlights the external myocardial rim of the LV. B: Coronary angiogram. A right anterior oblique view shows the guidewire (plain white arrows) introduced into a small branch of the left circumflex (LCx) artery just after its bifurcation with the left main coronary artery (LMCA). This branch is located in between the left anterior descending (LAD) artery and the LCx artery, heading toward the anterior wall. An ablation catheter (Cath) has been positioned at the anterobasal segment of the LV using a transseptal access. C and D: Two-chamber view transesophageal echocardiogram. A selective injection of echocardiographic contrast into the branch of the LCx artery revealed a superficially located hyperechogenicity between the basal left ventricle (LV) and the left atrial appendage (LAA) (panel D, white arrows) that was not present before infusion (panel C). LV = left ventricle; RV = right ventricle; Septal = first septal branch of the LAD artery. Heart Rhythm 2014 11, 143-145DOI: (10.1016/j.hrthm.2013.09.058) Copyright © 2014 Heart Rhythm Society Terms and Conditions