PMC6342612_01
A 12-lead electrocardiogram showing left-posterior fascicular ventricular tachycardia.
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An electrocardiogram exhibited wide QRS tachycardia (cycle length = 270 ms) with right bundle branch block and left axis deviation (Figure 1).
A: Right anterior oblique (RAO) and left anterior oblique (LAO) views of fluoroscopy during mapping of the left ventricle. B: A 3-dimensional map in the left ventricle (EnSite Velocity system). The yellow dots indicate the His bundle site. The aqua-lined dots indicate the site where the left-posterior fascicle potentials (P2) were recorded and the blue dots indicate the earliest P2 site. The white dots indicate the sites where the mid-to-late diastolic potentials (P1) were recorded. The orange dots indicate the sites where discrete P1 and subsequent P2 were recorded stably (PEN 1-4). Several local electrograms of P1 recorded with a PentaRay catheter (black arrowheads) were also shown in the map. We delivered radiofrequency energy to the site of the larger orange dot. C: Intracardiac electrogram during fascicular ventricular tachycardia. Earliest P2 and the subsequent ventricular potential were recorded at MAP 5, 6, and they conducted upward along the linear catheter (white downward arrows). P1, which could not be recorded with the linear catheter, were reproducibly recorded with the PentaRay catheter. P1 (black arrows) and subsequent P2 (white upward arrows) around the earliest P2 site were recorded stably at PEN 1, 2 and 3, 4. Square waves at MAP 7, 8 and PEN 13, 14 are artifacts.
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Jude Medical) (Figure 2A). A discrete P1 with subsequent P2 were recorded stably around the earliest P2 site (electrodes 1-4 of the PentaRay catheter in Figure 2A-C), and we tagged such sites in orange (Figure 2B).
A: Right anterior oblique (RAO) and left anterior oblique (LAO) views of fluoroscopy during application of radiofrequency (RF) energy. B: The large-tip mapping and ablation catheter could not record the late diastolic potentials during fascicular ventricular tachycardia (F-VT). After an application of RF energy was started, ventricular tachycardia terminated following prolongation of the tachycardia cycle length. C: Magnification of the comparison of the local electrograms recorded at the targeted P1 site using the linear duodecapolar catheter, the mapping and ablation catheter, and the PentaRay catheter, respectively, before an application of radiofrequency energy.
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Then, we positioned the irrigated mapping and ablation catheter with 7F, 4-mm tip and 3.5-mm center-to-center spaced electrodes to the site of the larger orange dot with a transseptal approach, but the P1 could not be recorded (Figure 3).