title: The origin of epicardial ventricular tachycardia revealed by entrainment from a permanent epicardial left ventricular pacing lead.
abstract: Entrainment From Left Ventricular Pacing Lead. Recognizing ventricular tachycardias (VTs) that require epicardial ablation is desirable, but challenging when prior surgery prevents percutaneous epicardial mapping. This patient had cardiomyopathy, prior cardiac surgery, and VT that failed endocardial ablation. Observing that the Bi-V implantable cardioverter defibrillator (ICD), left ventricular (LV) lead was epicardial to the area of infarct scar, it was used to pace during VT. Entrainment with concealed fusion with long stimulus to QRS interval, consistent with an epicardial VT circuit, was observed. Surgical cryoablation targeting the area around the LV lead eliminated VT. Thus pacing maneuvers from permanent epicardial leads can occasionally help identify an epicardial VT origin.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. inadi@jikei.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosman
authors.forename: Gregory
authors.initials: G
authors.lastname: Couper
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010496:Pericardium; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000517:prevention & control*