PMC4356701_01
Surface ECG recording taken during clinical ventricular tachycardia.. Note: Right bundle branch block, superior axis, A-V dissociation, and fusion beats (arrow) are seen on ECG.. Abbreviations: A, atria; ECG, electrocardiogram; V, ventricles.
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The ECG showed wide QRS tachycardia, suggestive of VT with a morphology of right bundle branch block (RBBB), left superior axis, and negative QRS concordance in precordial leads (Figure 1).
Intracardiac recordings.. Note: During clinical tachycardia, the ventricular potential recorded by the distal ablation catheter (ABLD) preceded the onset of surface QRS complex by 28 ms.. Abbreviations: A, atrial intracardiac electrogram; ABLD, distal ablation electrode; CSD, coronary sinus distal; CSP, coronary sinus proximal; rvad, right ventricle distal; rvap, right ventricle proximal; V, ventricular intracardiac electrogram.
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Although clinical tachycardia was easily reproduced by programmed right ventricular stimulation (Figure 2), entrainment was not seen with overdrive pacing.
Electroanatomic activation map of the left ventricle for clinical ventricular tachycardia, with the earliest activation and ablation site at the posterior mitral annulus (left anterior oblique view).. Notes: The isochronal activation map was constructed during tachycardia using proximal coronary sinus ventricular signal as a reference point. The color-coded display of the activation time in the left ventricle measured relative to the reference point. White color and blue color indicate the earliest and the latest activated sites, respectively. The activation map shows a very early target (white) in the posterior mitral annular area. Yellow and white catheters are coronary sinus catheter and the ablation catheter, respectively. The two circled areas indicate the best option for ablation.
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The earliest site of ventricular activation (preceding the onset of the surface QRS by 28 ms) was identified at the posterior wall of the LV (Figure 3).
Three-dimension electroanatomical mapping of the left ventricle.. Notes: Red dots indicate ablation lesions; After radiofrequency application, the termination of clinical tachycardia is seen on surface electrogram at the bottom of the figure. The two circled areas indicate the best option for ablation.. Abbreviation: VT, ventricular tachycardia.
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The first radiofrequency energy application (target temperature of 60 C, 50 W, 60 seconds) abolished VT (Figure 4).