Catheter ablation of ventricular tachycardia in the setting of electrical storm after revascularization of a chronic total occlusion of the right coronary.

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Presentation transcript:

Catheter ablation of ventricular tachycardia in the setting of electrical storm after revascularization of a chronic total occlusion of the right coronary artery: An uncommon presentation of reperfusion arrhythmia Sebastian Koenig, MD, Arash Arya, MD, FHRS, Gerhard Hindricks, MD, FHRS, Borislav Dinov, MD HeartRhythm Case Reports Volume 2, Issue 6, Pages 462-464 (November 2016) DOI: 10.1016/j.hrcr.2016.04.008 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Endocardial voltage mapping of the left ventricle (LV). A transseptal puncture and a steerable sheath were used to access the LV cavity. There is an inferior wall low-voltage area (<1.5 mV) with a total size of 86 cm² (36% of the LV surface). The dense scar (<0.5 mV) highlighted in red is surrounded by a broad penumbra zone (0.5–1.5 mV) with most of the late potentials (orange dots) localized at the border between both zones. Double potentials within electrophysiological study are represented by the light blue dots. HeartRhythm Case Reports 2016 2, 462-464DOI: (10.1016/j.hrcr.2016.04.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Twelve-lead electrocardiograms of the 4 monomorphic ventricular tachycardias (VTs) being induced during electrophysiological study. VT1 (cycle length [CL] 480 ms) and VT2 (CL 490 ms) were hemodynamically stable and therefore able to be mapped using concealed entrainment. VT3 (clinical VT, CL 335 ms) and VT4 (CL 390 ms) were mapped using pace mapping owing to hemodynamic impairment. HeartRhythm Case Reports 2016 2, 462-464DOI: (10.1016/j.hrcr.2016.04.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Endocardial voltage mapping of the left ventricle with ablation lines illustrated as red dots. Ventricular tachycardias (VTs) VT1 and VT2 were ablated successfully via short lines from the VT’s “critical isthmus” to the mitral annulus. Ablation lines transecting the scar area including the reentry circuits of VT3 and VT4 lead to noninducibility of all VTs. HeartRhythm Case Reports 2016 2, 462-464DOI: (10.1016/j.hrcr.2016.04.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions