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Case Reports
. 2020 Jul 4;6(10):690-693.
doi: 10.1016/j.hrcr.2020.06.023. eCollection 2020 Oct.

High-density substrate and activation mapping of epicardial ventricular tachycardia during left ventricular assist device implant

Alexander Kushnir  1 , Kristin H Pallister  2 , Salma B Chaudhary  1 , Marisa Cevasco  3 , Yoshifumi Naka  3 , Deepak Saluja  1
Affiliations
Case Reports

High-density substrate and activation mapping of epicardial ventricular tachycardia during left ventricular assist device implant

Alexander Kushnir et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Electroanatomic mapping; Epicardial VT ablation; LVAD; Substrate-based VT ablation; Ventricular tachycardia.

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Figures

Figure 1
Figure 1
Ventricular tachycardia (VT) electrocardiograms (ECG). Top: Twelve-lead ECG of clinical VT. Axis and morphology consistent with epicardial, basal, anterolateral focus. Bottom: Twelve-lead ECG of VT post–left ventricular assist device (LVAD) implant. Inferior apical septum exit site is consistent with an LVAD cannula origin.
Figure 2
Figure 2
Electroanatomic (EA) mapping. A: Placement of pads. Yellow circles: electrocardiogram limb electrodes; gray circles: defibrillation pads; black rectangle: sternotomy; colored circles: impedance mapping pads; blue rectangles: grounding pads. B: HD-Grid catheter (Abbott, Minneapolis, MN) depicting electrode and bipole orientation. Reprinted with permission from Abbott. C: Schematic of heart with red arrow identifying region that was mapped and ablated. Printed and modified with permission from Complete Heart Version 1.2, 3D4D medical. D: Sinus EA map. Left panel: Color scheme represents voltages from 0.05 to 1 mV. Region with scar (yellow circle) and region of conduction block (gray oval) are highlighted. Middle panel: Sinus isochronal late activation map (ILAM) depicting zones with conduction block (gray oval) and isochronal crowding (slow activation). Right panel: Example of electrical signals from each bipole on the HD-Grid demonstrating local abnormal ventricular activations (LAVA) and late potentials (LP) in the area with isochronal crowding. E: Ventricular tachycardia (VT) EA map. Left panel: HD-Grid positioned across the slow activation zone revealing fractionated, low-voltage, diastolic potentials, consistent with VT isthmus. Middle panel: Isochronal local activation time map (LAT) with arrow depicting a macroreentrant circuit ending with an endocardial dive. Gray oval corresponds to region of block observed during sinus activation mapping. Red and pink dots correspond to ablation lesions color coded by impedance drop (0–5, 5–10, >10 ohms). Right panel: HD-Grid positioned across the superior portion of the VT circuit revealing widely spaced doubles, consistent with conduction block. CL = cycle length.
See this image and copyright information in PMC

References

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