title: Pathological autopsy of a patient that underwent a successful ablation of an electrical storm from the left ventricular summit.
abstract: A 65-year-old man with non-ischemic cardiomyopathy, underwent an autopsy 2 months after the successful ablation of a sustained left ventricular (LV) summit ventricular tachycardia (VT). The patient died due to interstitial pneumonia from amiodarone use. The earliest activation sites of the VT were documented from both inside the anterior interventricular vein (AIV) and epicardial surface. The diameter of the AIV was 3-4 mm, and the radiofrequency (RF) lesion inside the AIV was a slight lesion due to high impedance with a high temperature. The lesion from the epicardial surface was also superficial and insufficient due to neighboring coronary arteries and the existence of epicardial fat. A successful application was performed from the LV endocardium, and diffuse myocardial fibrosis was observed in the mid-myocardium including inside the RF lesions. The actual relationship between the myocardial fibrosis and LV summit VT remains unclear, but this case showed the difficulty of achieving a successful ablation from the epicardial side, when the focus exists in the mid-myocardium around the LV summit.
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan. nshiro@dokkyomed.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.|Department of Pathology, Tokyo University Hospital, Tokyo, Japan.
authors.forename: Sohtaro
authors.initials: S
authors.lastname: Mine
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Anjo
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Fujii
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Taguchi
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001344:Autopsy; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D017809:Fatal Outcome; D005355:Fibrosis; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced; D008297:Male; D009206:Myocardium / Q000473:pathology*; D017180:Tachycardia, Ventricular / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Ablation; Left ventricular summit; Pathology; Ventricular tachycardia