Prolonged high-power endocardial ablation of epicardial microreentrant VT from the LV summit in a patient with nonischemic cardiomyopathy Jorge Romero,

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Prolonged high-power endocardial ablation of epicardial microreentrant VT from the LV summit in a patient with nonischemic cardiomyopathy Jorge Romero, MD, Olujimi A. Ajijola, MD, PhD, Noel Boyle, MD, PhD, FHRS, Kalyanam Shivkumar, MD, PhD, FHRS, Roderick Tung, MD, FHRS HeartRhythm Case Reports Volume 1, Issue 6, Pages 464-468 (November 2015) DOI: 10.1016/j.hrcr.2015.07.008 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Electroanatomic mapping with bipolar endocardial and epicardial voltage. Activation mapping on the epicardium showed focal propagation. Top: Left posterolateral view of endocardial and epicardial voltage map of LV. Left lateral view of epicardial activation mapping indicating earliest activation site in red (-50 ms). Bottom: Concealed entrainment from earliest site. TCL was 451ms and pacing was carried out at 430 ms. Post pacing interval (PPI) was 470. TCL-PPI: 15 ms. EGM-QRS=S-QRS(50 ms). Two fluoroscopic views demonstrate proximity to a diagonal coronary artery. HeartRhythm Case Reports 2015 1, 464-468DOI: (10.1016/j.hrcr.2015.07.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2. Constant fusion and subtle progressive fusion is demonstrated with pacing from the RV apex at different rates (390 ms and 430 ms) supporting a reentrant mechanism. HeartRhythm Case Reports 2015 1, 464-468DOI: (10.1016/j.hrcr.2015.07.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3. Endocardial ablation across from the earliest region of epicardial activation. The endocardial site is just after the onset of the QRS. Delayed termination (24s, 26s) was seen on two occasions and the patient was rendered noninducible. HeartRhythm Case Reports 2015 1, 464-468DOI: (10.1016/j.hrcr.2015.07.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions