Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report.

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Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report of two cases Siva M. Krothapalli, MD, Michael Giudici, MD, FHRS, Elaine Demetroulis, MD, Gardar Sigurdsson, MD, Gary Goldsmith, RT, Alexander Mazur, MD HeartRhythm Case Reports Volume 3, Issue 9, Pages 422-426 (September 2017) DOI: 10.1016/j.hrcr.2017.06.009 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: Twelve-lead electrocardiogram in sinus rhythm shows terminal QRS notching (J-point elevation) in leads II, III, and aVF. B: Epicardial electroanatomic voltage map in sinus rhythm. Sites with delayed potentials in the inferolateral left ventricle are marked with blue spheres. C: Examples of delayed potentials (arrows) recorded at the epicardial sites marked on the electroanatomic map in panel B with blue spheres. Note that timing of these potentials coincides with the terminal QRS notch in leads III and aVF. HeartRhythm Case Reports 2017 3, 422-426DOI: (10.1016/j.hrcr.2017.06.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Twelve-lead electrocardiogram of the induced ventricular tachycardia (VT). B: An example of presystolic local electrograms (D3-4) recorded during VT from the epicardial region with delayed potentials in sinus rhythm (marked with blue spheres in Figure 1B). C: Termination of VT with ablation at the site corresponding to D3-4 in panel B. HeartRhythm Case Reports 2017 3, 422-426DOI: (10.1016/j.hrcr.2017.06.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 A: Twelve-lead electrocardiogram (ECG) of the clinical ventricular tachycardia. B: Twelve-lead ECG in sinus rhythm shows terminal QRS notching in leads I and aVL (upper panel). Note augmentation of the terminal QRS notching after postextrasystolic pause in lead II (arrows, lower panel). C: Epicardial electroanatomic voltage map demonstrates 2 areas of abnormal electrograms, right ventricular outflow tract and lateral left ventricle (delineated by red ovals), as well as examples of the corresponding local electrograms (arrows). Sites with high-frequency multicomponent electrograms are tagged on the map with blue spheres. HeartRhythm Case Reports 2017 3, 422-426DOI: (10.1016/j.hrcr.2017.06.009) Copyright © 2017 Heart Rhythm Society Terms and Conditions