Dual intraventricular response after cardiac resynchronization

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Presentation transcript:

Dual intraventricular response after cardiac resynchronization Philippe Debruyne, MD, Peter Haemers, MD HeartRhythm Case Reports Volume 3, Issue 6, Pages 311-314 (June 2017) DOI: 10.1016/j.hrcr.2017.04.009 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: Baseline electrocardiogram (ECG) during biventricular pacing at 60 beats per minute showing an underlying left atrial flutter and bigeminy. The premature ventricular complexes have the same morphology and a coupling interval of 630 ms, indicated by the blue rectangle. B: Baseline ECG, after reprograming the lower pacing rate at 30 beats per minute, showing poor residual atrioventricular conduction with narrow QRS complexes and 2 different morphologies of premature ventricular complexes (PVCs) with the same coupling interval (580 ms). The red line corresponds to the beginning of the narrow QRS complexes. The blue rectangles indicate a longer PVC coupling interval (630 ms) during biventricular pacing at 60 beats per minute. C: Biventricular pacing at 80 beats per minute showing bigeminy with the same 2 different PVC morphologies. PVCs alternate and have a similar coupling interval compared with biventricular pacing at 60 beats per minute (blue rectangle). HeartRhythm Case Reports 2017 3, 311-314DOI: (10.1016/j.hrcr.2017.04.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Voltage map in right anterior oblique 30° view. The white dotted line (from * to **) indicates where the initial ablation line abolishing the premature ventricular complexes (PVCs) has been performed. B: Voltage map in a modified inferior view. Late abnormal ventricular activations: light blue dots; late potentials: dark blue dots; points with no ventricular capture: gray dots. C: Enlarged view of the pace map within the infarcted area. The borders of a conduction isthmus containing the point with the best pace map (*) are indicated by the yellow dotted lines. PVCs disappeared after completion of the line through the conduction isthmus (**). D: Match (93%) between the PVCs and the paced complex at the initial ablation site (*). HeartRhythm Case Reports 2017 3, 311-314DOI: (10.1016/j.hrcr.2017.04.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 A: Conventional mapping at the conduction isthmus exit site showing a fragmented signal 37 ms before QRS, with a QS pattern in the unipolar lead. B: Monomorphic ventricular tachycardia with a different QRS morphology compared with the premature ventricular complexes (PVCs). C: Electrograms within the QRS (▲) and nonconducted late potentials (♥) after ablation. The coupling interval of the latest late potential after ablation fits the coupling interval of the PVCs (700 ms) after anesthesia. The blue rectangle indicates the coupling interval of the PVCs before ablation (630 ms). HeartRhythm Case Reports 2017 3, 311-314DOI: (10.1016/j.hrcr.2017.04.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions