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Successful catheter ablation of idiopathic ventricular tachycardia originating from the top of the left ventricular posterior papillary muscle near the.

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Presentation on theme: "Successful catheter ablation of idiopathic ventricular tachycardia originating from the top of the left ventricular posterior papillary muscle near the."— Presentation transcript:

1 Successful catheter ablation of idiopathic ventricular tachycardia originating from the top of the left ventricular posterior papillary muscle near the chordae tendineae: Usefulness of intracardiac three-dimensional echocardiography  Hiroshi Kawakami, MD, Takashi Noda, MD, PhD, Koji Miyamoto, MD, Kazuhiro Satomi, MD, PhD, Wataru Shimizu, MD, PhD, Kengo F Kusano, MD, PhD  HeartRhythm Case Reports  Volume 1, Issue 3, Pages (May 2015) DOI: /j.hrcr Copyright © 2015 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Twelve-lead ECG recorded during the clinical ventricular tachycardia (VT) exhibits a QRS complex with right bundle branch block type morphology and left-axis deviation. B: Right anterior oblique fluoroscopic views (RAO) of the ablation catheter at the site of successful ablation. C: Left anterior oblique fluoroscopic views (LAO) of the ablation catheter at the site of successful ablation. The ablation catheter is located on the left ventricular posterior papillary muscle (LV PPM). D: Intracardiac electrogram recordings during the clinical VT. The local bipolar electrogram recorded from the ablation (ABL) catheter (ABL1-2) precedes QRS onset by 34 ms. There was a QS pattern in the ABL unipolar recording. I, II, V1, V6 = surface ECGs; ABL = ablation catheter; CS 1 to 6 = first to sixth electrode pairs of the coronary sinus catheter; LV 1 to 10 = first to tenth electrode pairs of the left ventricular catheter; HBE 1 to 4 = first to fourth electrode pairs of the His-bundle catheter; RVA 1 to 4 = first to fourth electrode pairs of the right ventricular catheter. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Three-dimensional left ventricular anatomic mapping using a CARTO-based 3-dimensional intracardiac echocardiography image integration system (CARTOSOUND). Yellow dot indicates site of successful ablation, which was located at the top of the left ventricular posterior papillary muscle (LV PPM) near the chordae tendineae. B: Intracardiac echocardiographic image showing the site of successful ablation. The tip of the ablation catheter, highlighted by a green marker, is touching the top of the LV PPM near the chordae tendineae. C: Two-dimensional short-axis cardiac magnetic resonance image at the level of the LV PPM. The ablation lesions are identified clearly by confined delayed enhancement at the top of the LV PPM near the chordae tendineae (red arrow). ABL = ablation catheter; PPM = posterior papillary muscle; RAO = right anterior oblique. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

4 Figure 3 Ventricular tachycardia (VT) was eliminated immediately after delivery of radiofrequency energy at the top of the left ventricular posterior papillary muscle (LV PPM) near the chordae tendineae. RFCA = radiofrequency catheter ablation; I, II, V1, V6 = surface ECGs; ABL = ablation catheter; CS 1 to 6 = first to sixth electrode pairs of the coronary sinus catheter; LV 1 to 10 = first to tenth electrode pairs of the left ventricular catheter; HBE 1 to 4 = first to fourth electrode pairs of the His-bundle catheter; RVA 1 to 4 = first to fourth electrode pairs of the right ventricular catheter. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

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