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Coronary artery vasospasm during catheter cryoablation of left ventricular summit nonsustained ventricular tachycardia  Santiago Rivera, MD, Maria de.

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Presentation on theme: "Coronary artery vasospasm during catheter cryoablation of left ventricular summit nonsustained ventricular tachycardia  Santiago Rivera, MD, Maria de."— Presentation transcript:

1 Coronary artery vasospasm during catheter cryoablation of left ventricular summit nonsustained ventricular tachycardia  Santiago Rivera, MD, Maria de la Paz Ricapito, MD, Josefina Parodi, MD, Pablo Spaletra, Gaston Albina, MD, Alberto Giniger, MD, Fernando Scazzuso, MD  HeartRhythm Case Reports  Volume 2, Issue 6, Pages (November 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 Brocq-Mouchet triangle composed by the intersection of the great cardiac vein (GCV), the circumflex artery (LCX), and the left anterior descending coronary artery (LAD). These structures are located between conus arteriosus and left auricle, on the left side of anterior surface of the heart. AIV = anterior interventricular vein. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Endocardial activation map of the same anatomical region. B: Activation map of the coronary sinus, showing the earliest activation at the LV summit epicardium, where the great cardiac vein receives the anterior interventricular vein (AIV). C: Clinical premature ventricular contraction with the earliest activity recorded at the AIV with a 46 ms ventricular electrogram-QRS. D: Pacemapping showing a 12/12 match and 24-point score. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 Fluoroscopic projections. Upper left image: Left anterior oblique (LAO) view of the coronary sinus phlebography showing the great cardiac vein (GCV) and anterior interventricular vein (AIV) distal to the inflated balloon. Upper right image: Right anterior oblique (view of the 6-mm focal cryoablation catheter placed at the most distal aspect of the GCV, toward the AIV. Lower left image: LAO view of the 6-mm focal cryoablation catheter placed at the bifurcation of a lateral branch of the circumflex (Cx) artery, where the earliest activity was recorded. Lower right image: LAO cranial view (Spider). A vasospasm of the lateral branch of the Cx is observed while cryoenergy is being delivered at the effective lesion site, reaching −82°C. A 4-mm irrigated-tip radiofrequency catheter was placed at the endocardial site (Kissing catheter). After cryoablation was completed and cryoenergy delivery discontinued (total dose of 240 seconds and 2 freeze-thaw-freeze cycles), a coronary angiogram was repeated. There was no vasospasm or coronary injury observed. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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