PMC4140187_01
Ventricular tachycardia with a RBBB morphology and right superior axis and VA dissociation. Note the "pseudo-delta" wave in lead V1 is suggesting an epicardial site of origin.
nihms-235555-f0001.jpg
PMC4140187_01_nihms-235555-f0001.jpg
F1
Seven months later, he experienced recurrent VT, with a different morphology (Figure 1).
ECGI isochrones and potential maps localizing the VT origin to the basal antero-lateral surface of the LV. Note the Q-wave morphology of the ECGI-reconstructed epicardial electrogram (EGM)at that site [inset], indicating an epicardial source. The asterisk in the isochrone map marks the site of earliest activation; the asterisk in the potential map is the local potential minimum associated with earliest activation.
nihms-235555-f0002.jpg
PMC4140187_01_nihms-235555-f0002.jpg
F2
ECGI localized the VT focus to the basal anterolateral aspect of the left ventricle (Figure 2).
CARTO electroanatomic activation maps in Left Anterior Oblique Cranial orientation. The radiofrequency energy applications are represented by the red spheres. Lesions 4-7 (labeled) affected the ventricular tachycardia. (Two points were collected during the 4th application).
nihms-235555-f0003.jpg
PMC4140187_01_nihms-235555-f0003.jpg
F3
The epicardial electroanatomic map is shown in Figure 3.
Gross, sectioned, and microscopic examination of the heart displays the epicardial ablation lesions. In each panel, the ablation lesions are indicated by the two white arrowheads. A: The lesions are seen at the basal anterolateral aspect of the whole heart. The lesions to the left of the arrowheads were superficial, as demonstrated in panel B. B: Section through the area ablation, revealing dense scar of ablation surrounded by scar from sarcoidosis. The depth of the lesion is 2 mm. C: The microscopic cross sectional examination shows that the ablation lesion is in an area affected by sarcoidosis. There is normal myocardium at the lower border of the panel.
nihms-235555-f0004.jpg
PMC4140187_01_nihms-235555-f0004.jpg
F4
Microscopic examination of the site of ablation also revealed ghosts of multinucleate giant cells, indicating that the ablated area was affected by the sarcoidosis (Figure 4).