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Volume 9, Issue 1, Pages (January 2012)

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Presentation on theme: "Volume 9, Issue 1, Pages (January 2012)"— Presentation transcript:

1 Volume 9, Issue 1, Pages 10-17 (January 2012)
Catheter ablation of ventricular tachycardia after left ventricular reconstructive surgery for ischemic cardiomyopathy  Adrianus P. Wijnmaalen, MD, Kurt C. Roberts-Thomson, MD, PhD, Daniel Steven, MD, Robert J.M. Klautz, MD, PhD, Stephan Willems, MD, PhD, Martin J. Schalij, MD, PhD, William G. Stevenson, MD, PhD, FHRS, Katja Zeppenfeld, MD, PhD  Heart Rhythm  Volume 9, Issue 1, Pages (January 2012) DOI: /j.hrthm Copyright © Terms and Conditions

2 Figure 1 Patient 5, in whom RFCA failed to abolish any of the five VTs that appeared to originate from behind the endoventricular patch. A: The morphologies of VT1–VT5 (sweep-speed 100 mm/s). B: The sagittal plane of a multislice CT scan after intravenous contrast demonstrating a space occupied with scar tissue (indicated by the word “scar”) that is excluded from the LV cavity by the endoventricular patch. C: The endocardial bipolar voltage map with the locations of the exit sites of VT1–VT5 bordering the endoventricular patch and indicated by arrows (color coding as in the color bar; gray is EUS representing the patch; voltage >1.5 mV is purple). D: The three-dimensional reconstruction of the CT images merged with the endocardial voltage map. Heart Rhythm 2012 9, 10-17DOI: ( /j.hrthm ) Copyright © Terms and Conditions

3 Figure 2 Example showing the activation and entrainment mapping of VT1 and VT2 in patient 5 (Figure 1). The exits of VT3–VT5 were identified using only activation or pace mapping. A: Twelve-lead QRS morphology of VT1 and VT2. B: EA activation maps of the LV during VT1 (top) and VT2 (bottom). The endoventricular patch was identified as an area of unexcitable scar and tagged in gray. Activation time is according to the color bar, with the earliest activation displayed in red. The white arrows indicate the site of earliest endocardial activation, entrainment mapping, and RF application (red tags). C: Intracardiac bipolar electrograms recorded from the distal, mid, and proximal electrode pairs of the ablation catheter at the border of the endoventricular patch for VT1 and VT2. D: Entrainment mapping of VT1 shows concealed entrainment while capturing the second electrogram component with an S-QRS interval of 25 ms, identical with the E-QRS, which is consistent with a VT exit site. Pacing at this site entrained the VT with concealed fusion with a postpacing interval (PPI) of 481 ms, which equaled VT CL. VT2 could be entrained with concealed fusion with a PPI of 486 ms (VT CL = 504 ms) and an S-QRS interval of 50 ms. Heart Rhythm 2012 9, 10-17DOI: ( /j.hrthm ) Copyright © Terms and Conditions

4 Figure 3 Patient 7, in whom RFCA was successful, abolishing two VTs by applying RF energy at the septal side of the endoventricular patch. A: The morphologies of VT1–VT2 (sweep-speed 100 mm/s). B: The sagittal plane of a multislice CT scan after intravenous contrast showing a small apical scar behind the endoventricular patch if compared with patient 5 (Figure 1). C: The endocardial bipolar voltage map with the locations of the exit sites of VT1–VT2 bordering the endoventricular patch and indicated by arrows (color coding as in the color bar; gray is EUS representing the patch). D: The three-dimensional reconstruction of the CT images merged with the endocardial voltage map. Heart Rhythm 2012 9, 10-17DOI: ( /j.hrthm ) Copyright © Terms and Conditions


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