Incremental value of electroanatomical mapping for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in a patient with sustained ventricular.

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Presentation transcript:

Incremental value of electroanatomical mapping for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in a patient with sustained ventricular tachycardia Simon A. Castro, MD, Rajeev K. Pathak, MBBS, PhD, Daniele Muser, MD, Pasquale Santangeli, MD, PhD, Anjali Owens, MD, Francis Marchlinski, MD, FHRS, Fermin C. Garcia, MD HeartRhythm Case Reports Volume 2, Issue 6, Pages 469-472 (November 2016) DOI: 10.1016/j.hrcr.2016.06.004 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Twelve-lead electrocardiogram (ECG) of the clinical ventricular tachycardia showing a left bundle branch block morphology, left inferior axis, and V4 precordial transition consistent with a right ventricular outflow tract/anterior right ventricular free wall origin. The wideness of the QRS (>140 ms) and the slow upstroke of the R wave (pseudo-delta wave), particularly evident in the inferior leads and in the left precordial leads, suggest a possible epicardial origin. B: The postcardioversion sinus rhythm 12-lead ECG shows only minor repolarization abnormalities (inverted T wave in V1 and biphasic T wave in V2) that fail to meet classic T wave changes that help establish the diagnosis of ARVC. HeartRhythm Case Reports 2016 2, 469-472DOI: (10.1016/j.hrcr.2016.06.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Electroanatomical mapping of the right ventricle showing A: a complete normal endocardial bipolar voltage (modified right anterior oblique view) and B: a small area of endocardial unipolar abnormality, consistent with mid-myocardial/subepicardial scar, on the anterior free wall (same view). C: A sustained ventricular tachycardia (VT) with 250 ms cycle length, matching the clinical VT, was induced with programmed ventricular stimulation. D: Epicardial mapping (same view) showed bipolar low-voltage areas (color range from blue to red) consistent with epicardial fat distribution; no bipolar abnormality was seen over the endocardial unipolar abnormality, but in this area late potentials during sinus rhythm (D: black dots and E: green arrow) and mid-diastolic potentials during VT (E: red arrow) were mapped and effectively targeted with radiofrequency (RF) with early VT termination and noninducibility at the consequent programmed ventricular stimulation. F: The final RF lesion set is shown. HeartRhythm Case Reports 2016 2, 469-472DOI: (10.1016/j.hrcr.2016.06.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions