A case of ventricular fibrillation triggered by ventricular premature depolarizations exiting from different sites of the Purkinje network Stavros E.

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Presentation transcript:

A case of ventricular fibrillation triggered by ventricular premature depolarizations exiting from different sites of the Purkinje network Stavros E. Mountantonakis, MD, Haisam Ismail, MD, David Lin, MD, FHRS HeartRhythm Case Reports Volume 1, Issue 6, Pages 439-441 (November 2015) DOI: 10.1016/j.hrcr.2015.06.004 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Clinical ventricular premature depolarization (VPD) in quadrigeminy at the beginning of the electrophysiology study, initiating ventricular fibrillation. Small differences in the morphology of each VPD are noted. Although these differences could be due to different timing in the respiratory cycle and/or changes in heart filling, we cannot rule out temporary changes in ventricular refractoriness or slight changes in exit. HeartRhythm Case Reports 2015 1, 439-441DOI: (10.1016/j.hrcr.2015.06.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 A: Endocardial bipolar electroanatomic map of the left ventricle showing large anterior, anteroseptal, and apical scar at the distribution of the left anterior descending artery infarct (voltage cutoffs 0.5–1.5 mV). The site of earliest mapping of each ventricular premature depolarization (VPD) is shown in the map. B: Morphology, activation times at earliest site, and coupling intervals of different VPDs. For VPDs 1 and 2 the timing from the onset of local electrogram to QRS is shown with vertical lines. Purkinje potentials preceded the local electrograms at earliest sites for VPDs 3 and 4 and are shown with red arrows. Abl = ablation catheter; D = distal; P = proximal; RVA = right ventricular apical catheter. HeartRhythm Case Reports 2015 1, 439-441DOI: (10.1016/j.hrcr.2015.06.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Endocardial bipolar electroanatomic map of the left ventricle showing the final lesion set targeting the anatomic location of the anterior and posterior fascicles (voltage cutoffs 0.5–1.5 mV). HeartRhythm Case Reports 2015 1, 439-441DOI: (10.1016/j.hrcr.2015.06.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions