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Arrhythmogenic substrate at the interventricular septum as a target site for radiofrequency catheter ablation of recurrent ventricular tachycardia in left dominant arrhythmogenic cardiomyopathy.

Havranek S, Palecek T, Kovarnik T, Vitkova I, Psenicka M, Linhart A, Wichterle D - BMC Cardiovasc Disord (2015)

Bottom Line: No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region.Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS.LDAC rarely manifests with sustained monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic. stepan.havranek@lf1.cuni.cz.

ABSTRACT

Background: Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive fibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV origin.

Case presentation: A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic ventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance imaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall myocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced during the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap rendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were induced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and ablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS.

Conclusion: LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both RBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation.

No MeSH data available.


Related in: MedlinePlus

The bipolar voltage map of both ventricles in sinus rhythm. An atypical range (2–4 mV) for color-coding was used to highlight the areas of subtle reduction of bipolar voltages. The cross denotes the left ventricular apicoseptal region of abnormal electrograms where the endomyocardial biopsy was taken. The arrow indicates the site with a maximum stimulus-to-QRS interval at the right-sided interventricular septum. The asterisk shows the site of the pacemap for the clinical tachycardia at the left-sided interventricular septum site with normal electrograms.
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Fig3: The bipolar voltage map of both ventricles in sinus rhythm. An atypical range (2–4 mV) for color-coding was used to highlight the areas of subtle reduction of bipolar voltages. The cross denotes the left ventricular apicoseptal region of abnormal electrograms where the endomyocardial biopsy was taken. The arrow indicates the site with a maximum stimulus-to-QRS interval at the right-sided interventricular septum. The asterisk shows the site of the pacemap for the clinical tachycardia at the left-sided interventricular septum site with normal electrograms.

Mentions: ECG in sinus rhythm, clinical ventricular tachycardia (VT #1) and three other induced VT morphologies during the electrophysiological procedure (VT #2 – #4). The pacemap for VT #1 is shown in the last column corresponding to the site marked by an asterisk in Figure 3.


Arrhythmogenic substrate at the interventricular septum as a target site for radiofrequency catheter ablation of recurrent ventricular tachycardia in left dominant arrhythmogenic cardiomyopathy.

Havranek S, Palecek T, Kovarnik T, Vitkova I, Psenicka M, Linhart A, Wichterle D - BMC Cardiovasc Disord (2015)

The bipolar voltage map of both ventricles in sinus rhythm. An atypical range (2–4 mV) for color-coding was used to highlight the areas of subtle reduction of bipolar voltages. The cross denotes the left ventricular apicoseptal region of abnormal electrograms where the endomyocardial biopsy was taken. The arrow indicates the site with a maximum stimulus-to-QRS interval at the right-sided interventricular septum. The asterisk shows the site of the pacemap for the clinical tachycardia at the left-sided interventricular septum site with normal electrograms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359501&req=5

Fig3: The bipolar voltage map of both ventricles in sinus rhythm. An atypical range (2–4 mV) for color-coding was used to highlight the areas of subtle reduction of bipolar voltages. The cross denotes the left ventricular apicoseptal region of abnormal electrograms where the endomyocardial biopsy was taken. The arrow indicates the site with a maximum stimulus-to-QRS interval at the right-sided interventricular septum. The asterisk shows the site of the pacemap for the clinical tachycardia at the left-sided interventricular septum site with normal electrograms.
Mentions: ECG in sinus rhythm, clinical ventricular tachycardia (VT #1) and three other induced VT morphologies during the electrophysiological procedure (VT #2 – #4). The pacemap for VT #1 is shown in the last column corresponding to the site marked by an asterisk in Figure 3.

Bottom Line: No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region.Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS.LDAC rarely manifests with sustained monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic. stepan.havranek@lf1.cuni.cz.

ABSTRACT

Background: Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive fibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV origin.

Case presentation: A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic ventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance imaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall myocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced during the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap rendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were induced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and ablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS.

Conclusion: LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both RBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation.

No MeSH data available.


Related in: MedlinePlus