PMC3271298_01
Initial ECG at emergency room. (A) Twelve lead ECG on admission revealed sustained monomorphic VT with LBBB configulation and left axis deviation. (B) Sinus rhythm with incomplete RBBB and normal QT interval (QTc:453 ms) was restored by electrical cardioversion.
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F1
SS included pulmonary interstitial fibrosis and mild pulmonary hypertension managed by prednisolone and azathioprine. She was admitted to the emergency department on July 17, 2009 and the initial electrocardiogram (ECG) revealed monomorphic wide QRS tachycardia which was well tolerated despite a rate of 243 beats per minute (Fig. 1A). Sinus rhythm with normal QT interval (QTc: 453 ms) was restored with electrical cardioversion (Fig. 1B).
Induced VT during the electrophysiologic study. This VT was morphologically identical with clinically documented VT (LBBB morphology and left axis deviation).
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F2
During the electrophysiological test, sustained ventricular tachycardia of the same morphology with clinically documented tachycardia was reproducibly induced by two ventricular extra stimuli (Fig. 2).
During substrate mapping in sinus rhythm, delayed and late potentials (black arrow) were identified at the mapping catheter.
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F3
During substrate mapping, delayed and isolated potential was found at the posterior base of the right ventricle (Fig. 3).
Pacemapping at the area of late potential showed good matching with induced VT. (A) 12 lead ECG during pacemapping (B) 12 lead ECG duing ventricular tachycardia.
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F4
Pacemapping in the area showed satisfactory 12-lead QRS matching with induced ventricular tachycardia (Fig. 4).