Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Feb 16;4(4):185-191.
doi: 10.1016/j.jaccas.2021.12.007.

Subcutaneous ICD Implantation and Catheter Ablation: A Step-Planned Approach for Ventricular Tachycardia Management in ARVC

Aurora Sanniti  1 , Domenico Zagari  1   2 , Elvira Renzullo  1 , Chiara Valeriano  2 , Paolo Moretti  1 , Giammario Spadacini  1 , Massimo Tritto  1   2
Affiliations
Case Reports

Subcutaneous ICD Implantation and Catheter Ablation: A Step-Planned Approach for Ventricular Tachycardia Management in ARVC

Aurora Sanniti et al. JACC Case Rep. .

Abstract

Secondary prevention of sudden cardiac death in the young patient with arrhythmogenic right ventricular cardiomyopathy and hemodynamically tolerated ventricular tachycardia is still a challenging field. We present a combined approach, including subcutaneous implantable cardioverter-defibrillator (ICD) and catheter ablation, as a promising treatment to prevent both ventricular tachycardia recurrences and ICD shocks. (Level of Difficulty: Intermediate.).

Keywords: 3D-EAM, 3-dimensional electroanatomical map; ARVC, arrhythmogenic right ventricular cardiomyopathy; ATP, antitachycardia pacing; CA, catheter ablation; CMR, cardiac magnetic resonance; ECG, electrocardiogram; ED, emergency department; EP, electrophysiological; ICD, implantable cardioverter-defibrillator; LBBB, left bundle branch block; LP, late potential; LV, left ventricle; NSVT, nonsustained ventricular tachycardia; PVS, programmed ventricular stimulation; RV, right ventricular; S-ICD, subcutaneous implantable cardioverter-defibrillator; VT, ventricular tachycardia; arrhythmogenic right ventricular cardiomyopathy; subcutaneous ICD; ventricular tachycardia ablation.

PubMed Disclaimer

Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Baseline 12-Lead Electrocardiogram The tracings show inverted T waves in leads V1 to V2.
Figure 2
Figure 2
Results of Programmed Ventricular Stimulation Multiple induced (A and B) monomorphic or (C) polymorphic nonsustained ventricular tachycardias with left bundle branch block configuration and different axis deviation.
Figure 3
Figure 3
Endocardial Electroanatomical Map and Intracardiac Recordings (A to D) Electroanatomical mapping and recording. (A) A right ventricular bipolar endocardial electroanatomical map (EAM) shows a region (surface 19.6 cm2) of abnormal voltages consistent with dense scar (≤0.5 mV) (red) and a border zone (0.5-1.5 mV) (yellow to blue) located at the anterior aspect of the outflow tract. Within this area, (C) far-field late potentials were recorded (blue arrows), and (D) ventricular pacing resulted in local ventricular capture (short-stimulus QRS interval) without late potential capture, thus confirming their remote origin (from epicardium). (B) The right ventricular unipolar endocardial substrate map shows a more extensive epicardial scar (53.2 cm2). The right bundle branch block pattern in C was mechanically induced. LAO = left anterior oblique; RVA = right ventricular apex; SITE = mapping catheter.
Figure 4
Figure 4
Monomorphic Sustained Ventricular Tachycardia Successfully Treated by Subcutaneous Implantable Cardioverter-Defibrillator Shock
Figure 5
Figure 5
Epicardial Substrate Map (A) The bipolar map shows an extensive abnormal voltage area (<1 mV) (red to blue) mirroring in location that detected at the endocardial electroanatomical map (Figure 3D). (B) The right ventricular activation map during sinus rhythm demonstrates a centripetal gradient of delayed activation (red to purple) within the abnormal voltage area. (C) Ablation sites shown by red dots. (D) Examples of single or multicomponent late potentials (arrows) with different activation delays recorded during sinus rhythm within the abnormal substrate. The vertical lines indicate the end of the QRS complex. (E) Electrical stimulation from this area results in direct late potential capture with a prolonged-stimulus QRS interval (see also text). HBE = His bundle electrogram; RVA = right ventricular apex; SITE = ablation catheter.
See this image and copyright information in PMC

References

    1. Caforio A.L.P., Pankuweit S., Arbustini E., et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34:2636–2648. - PubMed
    1. Marcus F.I., McKenna W.J., Sherrill D., et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Eur Heart J. 2010;31:806–814. - PMC - PubMed
    1. Towbin J.A., McKenna W.J., Abrams D.J., et al. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm. 2019;16(11):e301–e372. - PubMed
    1. Santangeli P., Zado E.S., Supple G.E., et al. Long-term outcome with catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. 2015;8:1413–1421. - PubMed
    1. Santangeli P., Hamilton-Craig C., Dello Russo A., et al. Imaging of scar in patients with ventricular arrhythmias of right ventricular origin: cardiac magnetic resonance versus electroanatomic mapping. J Cardiovasc Electrophysiol. 2011;22:1359–1366. - PubMed

Publication types