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Case Reports
. 2015 May 21;1(5):310-314.
doi: 10.1016/j.hrcr.2015.04.003. eCollection 2015 Sep.

Pathology after combined epicardial and endocardial ablation for ventricular tachycardia in a postmortem heart with hypertrophic cardiomyopathy

Kenzaburo Nakajima  1 , Koji Miyamoto  1 , Taka-Aki Matsuyama  2 , Takashi Noda  1 , Hatsue Ishibashi-Ueda  2 , Kengo Kusano  1
Affiliations
Case Reports

Pathology after combined epicardial and endocardial ablation for ventricular tachycardia in a postmortem heart with hypertrophic cardiomyopathy

Kenzaburo Nakajima et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Ablation; ECG, electrocardiogram; HCM, hypertrophic cardiomyopathy; Hypertrophic cardiomyopathy; LV, left ventricle; LVZ, low-voltage zone; NICM, nonischemic cardiomyopathy; Pathology; RF, radiofrequency; RFCA, radiofrequency catheter ablation; VT, ventricular tachycardia; Ventricular tachycardia.

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Figures

Figure 1
Figure 1
A: A representative 12-lead electrocardiogram of clinical ventricular tachycardia (VT). The VT exhibited a right bundle branch block pattern and a right superior axis. VT cycle length is 330 ms, with a widened QRS duration and a slowed initial precordial QRS activation, indicating that the VT is of epicardial origin. B: Six VTs induced by right ventricular pacing.
Figure 2
Figure 2
Comparison between the macroscopic view of the epicardial surface and the electroanatomic voltage map. A: Epicardial voltage map of the left ventricle (LV) from the left lateral cranial direction. Blue, green, yellow, and red areas indicate the progressively low-voltage zones (LVZs), defined as <1.0 mV. Brown dots indicate ablation points. Pink dots indicate abnormal electrocardiograms including the delayed potentials, fragmented potentials, and double potentials. B: Endocardial voltage map of the LV from the left lateral cranial direction. Brown dots indicate ablation points. The LVZ, defined as <1.5 mV, is located lateral to the posterior wall in the LV endocardium. C: The macroscopic view of the LV corresponds to Figure 2A before fixation in formalin. Rich adipose tissue covers the epicardial surface. The opaque discolored yellow area encircled by the dotted line indicates the ablation lesion. The location of the fatty tissue and uncovered myocardium roughly corresponds to the findings of epicardial voltage map. The white line labeled b indicates the cutting line in Figure 3B. Microscopic findings at lines a, c, and d are shown in the Supplemental Figure (available online). RV = right ventricle.
Figure 3
Figure 3
Cross sections of the ablated lesions, post formalin fixation. A: Macroscopic endocardial overview of the left ventricle (LV) in the 4-chamber cut. The ventricular septum (VS) shows asymmetric hypertrophy, and the apex shows aneurysmal dilation with the wall thinning. Ablated lesions (white and yellow arrowheads) are located in the dilated lesion. B: Cross-sectional macroscopic finding at the white line in Figure 2C. Yellow arrowheads indicate ablated lesions in epicardial fat, which is approximately 2–4 mm thick. Blackish areas are observed at deeper sites in the endocardium. C: Microscopic findings from Figure 3B with Masson’s trichrome stain. Irregular fibrotic layers that are originally caused by hypertrophic cardiomyopathy (HCM) are mainly distributed in the center of the LV wall (black arrows). The yellow dotted line represents an ablation lesion from the endocardium. Within this area, hemorrhagic necrosis is observed. The red line represents an ablation lesion from the epicardium, and the ablation scar reached a maximum depth of 6 mm. On the epicardium, the maximum depth of the ablation scar was only 2 mm beyond the epicardial adipose tissue. Myocardium that escaped the ablation energy was visible between the epicardial and endocardial ablation lesions. CS = coronary sinus, LA = left atrium, TV = tricuspid valve, RV = right ventricle, MV = mitral valve, END = endocardium, EPI = epicardium.
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References

    1. Soejima K., Stevenson W.G., Sapp J.L., Selwyn A.P., Couper G., Epstein L.M. Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol. 2004;43:1834–1842. - PubMed
    1. Desjardins B., Yokokawa M., Good E., Crawford T., Latchamsetty R., Jongnarangsin K., Ghanbari H., Oral H., Pelosi F., Jr, Chugh A., Morady F., Bogun F. Characteristics of intramural scar in patients with nonischemic cardiomyopathy and relation to intramural ventricular arrhythmias. Circ Arrhythm Electrophysiol. 2013;6:891–897. - PubMed
    1. De Cobelli F., Pieroni M., Esposito A., Chimenti C., Belloni E., Mellone R., Canu T., Perseghin G., Gaudio C., Maseri A., Frustaci A., Del Maschio A. Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J Am Coll Cardiol. 2006;47:1649–1654. - PubMed
    1. Sosa E., Scanavacca M., D’avila A., Pilleggi F. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996;7:531–536. - PubMed
    1. Maury P., Escourrou G., Guilbeau C., Duparc A., Hebrard A., Delay M. Histopathologic effects of endocardial and epicardial percutaneous radiofrequency catheter ablation in dilated nonischemic cardiomyopathy. Pacing Clin Electrophysiol. 2008;31:1218–1222. - PubMed

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