Samuel H. Baldinger, MD, Saurabh Kumar, MD, PhD, Alan D

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Date of download: 6/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: Entrainment mapping and radiofrequency catheter.

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Presentation transcript:

Options for ventricular tachycardia ablation after double valve replacement Samuel H. Baldinger, MD, Saurabh Kumar, MD, PhD, Alan D. Enriquez, MD, Piotr S. Sobieszczyk, MD, Roy John, MD, PhD, FHRS, William G. Stevenson, MD, FHRS HeartRhythm Case Reports Volume 1, Issue 4, Pages 163-166 (July 2015) DOI: 10.1016/j.hrcr.2015.02.007 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Tc-99m sestamibi rest myocardial perfusion single-photon emission computerized tomographic study showing a severely dilated left ventricle with a large region of myocardial scar in the distribution of the distal left circumflex coronary artery (left panels). The epicardial voltage map (left lateral view) shows a large inferolateral area of low bipolar voltage <1.5 mV (middle panel) and unipolar voltage <8.3 mV (right panel). ANT = anterior; Bi = bipolar voltage; INF = inferior; LAT = lateral; Uni = unipolar voltage. HeartRhythm Case Reports 2015 1, 163-166DOI: (10.1016/j.hrcr.2015.02.007) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Three fast ventricular tachycardia (VT) morphologies different from the documented VT were induced from the right ventricular (RV) apex (VT1–VT3). Another 3 VTs with different morphologies consistent with origin in the lateral scar area, all with right bundle block-like morphology in lead V1 and right frontal plane axis, were induced by pacing in the epicardial scar area (VT5–VT6). VT6 was induced after the first transcoronary ethanol ablation (TCEA) and remained inducible. HeartRhythm Case Reports 2015 1, 163-166DOI: (10.1016/j.hrcr.2015.02.007) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Entrainment mapping from the ablation catheter positioned in the inferolateral epicardial scar, where transcoronary ethanol ablation was subsequently performed, showing concealed fusion with a postpacing interval of 25 ms. Abl = ablation catheter; dist = distal; prox = proximal. HeartRhythm Case Reports 2015 1, 163-166DOI: (10.1016/j.hrcr.2015.02.007) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 4 Overlay of coronary angiography and epicardial voltage map showing distal branches of a marginal branch (arrows) supplying the inferolateral area where the ablation catheter is located. HeartRhythm Case Reports 2015 1, 163-166DOI: (10.1016/j.hrcr.2015.02.007) Copyright © 2015 Heart Rhythm Society Terms and Conditions