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
. 2023 Mar 24;9(6):386-390.
doi: 10.1016/j.hrcr.2023.03.012. eCollection 2023 Jun.

Omnipolar mapping technology used in a patient with Purkinje-related ventricular tachycardia

Yousaku Okubo  1 , Shogo Miyamoto  1 , Naoto Oguri  1 , Sho Okamura  1 , Takehito Tokuyama  1 , Yukiko Nakano  1
Affiliations
Case Reports

Omnipolar mapping technology used in a patient with Purkinje-related ventricular tachycardia

Yousaku Okubo et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Catheter ablation; High-density 3D mapping; Omnipolar mapping; Purkinje-related ventricular tachycardia; Ventricular tachycardia after myocardial infarction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A: Twelve-lead electrocardiogram (ECG) during atrial fibrillation rhythm at baseline. B: ECG during monomorphic sustained ventricular tachycardia showed relatively narrow QRS complexes (134 ms), a right bundle branch block, and a superior-left axis deviation. C, D: Fluoroscopic images showing the catheter position. CS = coronary sinus; HDG = HD grid catheter; LAO = left anterior oblique; LPF = left posterior fascicle; LV = left ventricular; RAO = right anterior oblique.
Figure 2
Figure 2
A: The omnipolar voltage map of the left ventricle shows the low-voltage area on the inferior wall. The low-voltage and dense scarred areas were defined as areas with peak-to-peak voltages of 0.1–0.6 and <0.1 mV, respectively. B: Endocardial electrograms (EGMs) during intrinsic atrial fibrillation (AF) rhythm and clinical ventricular tachycardia. (a) and (b) show the EGMs when the HD grid mapping catheter was located at (a) and (b) in panel (A), respectively. During intrinsic AF rhythm, the impulse propagated in the antegrade direction, from the proximal to distal sites in the left posterior fascicle (LPF) (indicated by the red arrow in Figure 2B). However, during clinical ventricular tachycardia (VT), the impulse propagated retrogradely from the distal to proximal sites of the LPF (indicated by the yellow arrow in Figure 2B). C: The bipolar local activation time (LAT) mapping during the clinical VT. D: Omnipolar LAT mapping and the activation vector. The activation vector revealed that the impulse propagated from the earliest activation site to the LPF and broke out from the LPF to the entire myocardium. The earliest LAT point was −48 ms and the latest LAT point was 184 ms, and the LAT range was only about 50% of the tachycardia cycle length (TCL). E: EGMs during entrainment pacing at each pacing site (a–d). The interval from the stimulus to the onset of the following QRS complex during entrainment (S-QRS) and the PPI after entrainment at each pacing site are shown on the bottom right side of (E).
Figure 3
Figure 3
A: Schematic representation of the re-entrant mechanism for ventricular tachycardia (VT). B: Three-dimensional electroanatomic map during the radiofrequency application. An 8F, 4 mm flexible irrigated-tip catheter with 2-2-2-mm interelectrode spacing (TactiCathTM SE Ablation Catheter; Abbott, St. Paul, MN) was positioned at the early activation site during the VT. C: Fluoroscopic images showing the catheter position. D: The VT was immediately terminated when applying radiofrequency energy (35 W).
See this image and copyright information in PMC

References

    1. de Bakker J.M., van Capelle F.J., Janse M.J., et al. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation. 1988;77:589–606. - PubMed
    1. Nogami A. Purkinje-related arrhythmias part I: monomorphic ventricular tachycardias. Pacing Clin Electrophysiol. 2011;34:624–650. - PubMed
    1. Bogun F., Good E., Reich S., et al. Role of Purkinje fibers in post-infarction ventricular tachycardia. J Am Coll Cardiol. 2006;48:2500–2507. - PubMed
    1. Hayashi M., Kobayashi Y., Iwasaki Y., et al. Novel mechanism of postinfarction ventricular tachycardia originating in surviving left posterior Purkinje fibers. Heart Rhythm. 2006;3:908–918. - PubMed
    1. Deno D.C., Bhaskaran A., Morgan D.J., et al. High-resolution, live, directional mapping. Heart Rhythm. 2020;17:1621–1628. - PubMed

Publication types

LinkOut - more resources