HeartRhythm Case Reports

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HeartRhythm Case Reports Percutaneous catheter ablation of malignant, recurrent ventricular arrhythmia in a 10- month-old toddler Linda Koutbi, MD, Philippe Aldebert, MD, Virginie Fouilloux, MD, Stéphane Le Bel, MD, Jean-Claude Deharo, MD, Frédéric Franceschi, MD, PhD HeartRhythm Case Reports DOI: 10.1016/j.hrcr.2019.02.011 Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 1 External defibrillation of a ventricular fibrillation (VF) episode. Six-lead electrocardiogram recorded at the patient’s arrival in our institution. The VF was converted to sinus rhythm for only 3 beats, interrupted by a premature ventricular contraction (PVC). Then a very rapid ventricular tachycardia started with the same morphology compared to the PVC. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.02.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 2 Beginning of a ventricular arrhythmia episode. This episode happened despite a maximal medical treatment, under extracorporeal membrane oxygenation. The first line is a normal sinus rhythm. At the end of the second line, a rapid ventricular tachycardia started, converting into ventricular fibrillation few seconds later at the end of the third line. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.02.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 3 Catheter ablation procedure. The upper left panel is a left lateral view of the left ventricle using a three-dimensional system (Velocity, St. Jude Medical, Saint Paul, MN). The ablation points are represented in green; the mitral annulus is represented in blue. The upper right panel is an anteroposterior fluoroscopic view. The Agilis sheath (St. Jude Medical) is in the right atrium. The ablation catheter crosses the interatrial septum and is located at the successful site in the left ventricle. The lower left panel shows a 12-lead electrocardiogram (ECG) representing a 12/12 pace map followed by 3 beats of normal sinus rhythm and the spontaneous ventricular tachycardia (VT). The lower right panel shows a 12-lead ECG at the beginning of the successful radiofrequency application. The disappearance of the VT is observed 11 seconds after the radiofrequency was turned on. ST-segment changes can be observed. These could be due to ischemic phenomenon relative to incessant ventricular arrhythmia. The ischemia may have be worsened by the radiofrequency current application itself on the lateral wall of the left ventricle. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.02.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions