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Progressive electrical remodeling in apical hypertrophic cardiomyopathy leading to implantable cardioverter-defibrillator sensing failure during ventricular.

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Presentation on theme: "Progressive electrical remodeling in apical hypertrophic cardiomyopathy leading to implantable cardioverter-defibrillator sensing failure during ventricular."— Presentation transcript:

1 Progressive electrical remodeling in apical hypertrophic cardiomyopathy leading to implantable cardioverter-defibrillator sensing failure during ventricular fibrillation  Blake E. Fleeman, MD, Boaz Avitall, MD, PhD, FHRS  HeartRhythm Case Reports  Volume 3, Issue 1, Pages (January 2017) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Echocardiographic appearance of this patient’s left ventricular apical hypertrophy. B: Progressive electrical changes over time per surface electrocardiograms (ECGs) (N = 47). R-wave amplitude and T-wave amplitude both declined over time. Units are in mV (millimeters have been converted accordingly from each ECG’s calibration). Examples of V4 complexes are displayed on the right (R-wave reduction −37%, ST −96%). HeartRhythm Case Reports 2017 3, 43-48DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 Electrogram as recorded by the device at the onset of ventricular fibrillation (VF) demonstrates failure to sense VF. HeartRhythm Case Reports 2017 3, 43-48DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Electrograms prior to placing the right ventricular (RV) septal lead. B: Catheter placement is shown with a 20-pole mapping catheter in the right ventricle that has been advanced as distally as possible to approximate sensing at the apical lead and a 4-pole mapping catheter to approximate the high septal activity. The apical activity (DD1–2) is fractionated, low-amplitude signal during ventricular fibrillation (VF). However, the same activity is discrete and high-amplitude at the basilar RV septum. C: New RV septal lead with associated electrogram during induced VF with cleaner signal (red) as compared to the old lead (blue), also with activity during VF. HeartRhythm Case Reports 2017 3, 43-48DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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