Ventricular tachycardia originating from the epicardium identified by intracoronary mapping using a PTCA guidewire.
We report a case in which endocardial radiofrequency (RF) ablation guided by unipolar intracoronary mapping using a guidewire was an effective therapy for treating VT originating from an epicardial site of the left ventricle. A 55-year-old man with dilated cardiomyopathy was referred for treatment of refractory sustained monomorphic VT. The earliest unipolar electrogram with a near-perfect pace map was identified at segment #8 of the left anterior descending artery utilizing a guidewire through a microtube catheter during the VT. VT was terminated by an endocardial RF application at an upper midventricular septal site that did not have a good pacemap or the earliest electrogram, and that was the most adjacent anatomical endocardial site to the guidewire tip. No VT was clinically observed during a follow up period of 14 months.
Kumagai
Koji
K
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Machi, Sendai, Japan. kkumagai@cardio.med.tohoku.ac.jp
Takahashi
Atsushi
A
Yamauchi
Yasuteru
Y
Aonuma
Kazutaka
K
D006328:Cardiac Catheterization / Q000295:instrumentation*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000295:instrumentation*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology*; D015641:Radiography, Interventional; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery