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Case Reports
. 2021 Jan-Mar;14(1):107-112.
doi: 10.4103/apc.APC_84_20. Epub 2020 Nov 25.

Re-entrant ventricular tachycardia in a postoperative case of tetralogy of Fallot - Ablated successfully under the three-dimensional mapping system

Suresh Kumar Paidi  1 , Krishna Kumar Mohanan Nair  1 , Narayanan Namboodiri  1 , Sridhar Balaguru  1 , Ajitkumar Valaparambil  1
Affiliations
Case Reports

Re-entrant ventricular tachycardia in a postoperative case of tetralogy of Fallot - Ablated successfully under the three-dimensional mapping system

Suresh Kumar Paidi et al. Ann Pediatr Cardiol. 2021 Jan-Mar.

Abstract

A 47-year-old female underwent cardiac repair for tetralogy of Fallot at the age of 12 years. Subsequently, she was asymptomatic on follow-up. Recently, she presented elsewhere with palpitations and presyncope with documented ventricular tachycardia (VT) having left bundle branch block morphology with inferior QRS axis and late precordial transition. She was reported to have cardioverted and referred to our center for electrophysiology study (EP). She underwent EP study which induced clinical VT which was hemodynamically stable and the mechanism of VT was confirmed as re-entry. With the help of three-dimensional mapping system, VT circuit was identified in the posterior right ventricular outflow tract region between the pulmonary valve and upper end of ventricular septal defect patch. Delivery of radiofrequency energy during VT terminated the tachycardia with no further inducible VT despite aggressive pacing protocols.

Keywords: Catheter ablation; tetralogy of Fallot; ventricular tachycardia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Surface electrocardiogram showing ventricular tachycardia with left bundle branch block morphology. (b) Surface electrocardiogram during sinus rhythm
Figure 2
Figure 2
(a) Voltage map of the right ventricle in right anterior oblique (RAO) and leftanterior oblique (LAO) views. (b) Voltage map of the right ventricle in anteroposterior and posteroanterior views
Figure 3
Figure 3
(a) 12-lead surface electrocardiogram of the ventricular tachycardia induced in EP lab. (b) Surface electrocardiogram-leads I, aVF, V1, V6 and intracardiac electrograms – RFD (mapping and ablation distal), RFP (mapping and ablation proximal), his bundle electrogram distal, his bundle electrogram proximal – showing mid diastolic potentials (*) during the ventricular tachycardia with mapping catheter positioned at the posterior wall of right ventricular outflow tract
Figure 4
Figure 4
Activation mapping during ventricular tachycardia showing “early meets late” pattern suggestive of re-entry at posterior right ventricular outflow tract
Figure 5
Figure 5
(a) Surface electrocardiogram during ventricular entrainment showing entrainment with concealed fusion. (b) Surface electrocardiogram-leads I, aVF, V1, V6 and intracardiac electrograms – RFD (mapping and ablation distal), RFP (mapping and ablation proximal), his bundle electrogram distal, his bundle electrogram proximal – showing post entrainment response
Figure 6
Figure 6
(a) Surface electrocardiogram-leads I, aVF, V1, V6 and intracardiac electrograms – RFD (mapping and ablation distal), RFP (mapping and ablation proximal), his bundle electrogram distal, his bundle electrogram proximal – showing termination of ventricular tachycardia on radiofrequency ablation. (b) Surface electrocardiogram-leads I, aVF, V1, V6, and intracardiac electrograms – RFD (mapping and ablation distal), RFP (mapping and ablation proximal), his bundle electrogram distal, his bundle electrogram proximal – showing no inducible ventricular tachycardia despite delivering triple extra stimuli from the right ventricular apex
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