Successful ablation of ventricular tachycardia arising from a midmyocardial septal outflow tract site utilizing a simplified bipolar ablation setup Peter.

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Successful ablation of ventricular tachycardia arising from a midmyocardial septal outflow tract site utilizing a simplified bipolar ablation setup Peter J. Sauer, Megan J. Kunkel, BS, Duy T. Nguyen, MD, FHRS, Austin Davies, CEPS, CCDS, Curtis Lane, CEPS, CCDS, Wendy S. Tzou, MD, FHRS HeartRhythm Case Reports Volume 5, Issue 2, Pages 105-108 (February 2019) DOI: 10.1016/j.hrcr.2018.11.002 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Twelve-lead electrocardiogram morphologies of 3 predominant premature ventricular complexes (PVC1–3) at baseline (white panels) and induced monomorphic ventricular tachycardias (VT1, VT2, blue panels). HeartRhythm Case Reports 2019 5, 105-108DOI: (10.1016/j.hrcr.2018.11.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A: Electroanatomic bipolar voltage map of the left ventricle (LV), demonstrating normal bipolar voltage except in the outflow tract, just above and below the level of the aortic valve, extending from the septum anteriorly and laterally to the aortomitral continuity (AMC). Sites of earliest activation for ventricular tachycardia (VT) 1 and 2 are highlighted within regions of abnormal bipolar voltage (blue stars). B: Intracardiac echocardiography (ICE) depicts the location of midmyocardial substrate between the right ventricular outflow tract (RVOT) and the left ventricular outflow tract (LVOT). A residual steam pop lesion resulting from unipolar ablation using 50 watts on the right ventricle side of the septum (after high-power unipolar lesions applied to the LV side of the septum failed to render VT noninducible) is also shown. Note that the depth of the lesion does not appear to penetrate to the target of greatest interest. The interventricular septal distance measured at this location was 1.1 cm. HeartRhythm Case Reports 2019 5, 105-108DOI: (10.1016/j.hrcr.2018.11.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A, B: The T-cable and associated connections utilized to create a bipolar radiofrequency ablation circuit using standard unipolar ablation equipment. (See text for details.) C: The active and ground catheters as displayed on the electroanatomic mapping system, with associated intracardiac electrograms (lower left), and the impedance trend (lower right) during bipolar ablation; 3-dimensional reconstructions of the right ventricular outflow tract (light blue), the left ventricular outflow tract and aortic arch (red), and left ventricle (tan) are displayed in left lateral (left) and cranial right anterior oblique (right) projections. HeartRhythm Case Reports 2019 5, 105-108DOI: (10.1016/j.hrcr.2018.11.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions