Catheter Ablation for Ventricular Tachycardia in Patients With Biopsy-Proven Myocarditis

Figures

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  Figure 1. Flow Chart of Patient Screening Initially, 115 patients with antiarrhythmic drug (AAD)-refractory ventricular tachycardia (VT) undergoing endomyocardial biopsy (EMB) were included in this study. After applying the exclusion criteria, 65 patients were excluded, resulting in a final study cohort of 50 patients. CA = catheter ablation; CS = cardiac sarcoidosis; GCS = giant cell myocarditis.

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  Figure 2. Example of VT Mapping and Ablation A patient had 6 ventricular tachycardia events in the past year, the histological diagnosis was lymphocytic myocarditis. No target areas containing late potential electrograms were found in left ventricular (LV) endo-myocardium; therefore, the internal surface of the epicardium (epi) was accessed. The depicted area primarily covers the epicardium of the LV inferolateral wall. (A) Activation (left) and voltage mappings (right) during sinus rhythm. The focal areas with low voltage and late potentials were shown. (B) Activation sequence of late potentials was from both ends (H1-2 and H7-8) to center electrode (H3-4) of the mapping catheter (arrows). (C) The recorded late potentials and diagram of the propagation during sinus system. The activation reached the core collection area of late potentials from all directions (arrows); (D) Clinical ventricular tachycardia occurred during ablating in the area with late potentials. After extended ablation, ventricular tachycardia was terminated and cannot be induced.

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  Central Illustration. Overview of This Study 50 patients with VT and biopsy-proven myocarditis from 2 centers are included. VT recurrences of ablation and drug groups by 1-year follow-up are shown. AAD = antiarrhythmic drug; CA = catheter ablation; VT = ventricular tachycardia.

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  Figure 3. Kaplan-Meier Survival Curve of Ventricular Tachycardia Recurrences by 1-Year Follow-Up The noncatheter ablation (CA) group exhibited a higher rate of ventricular tachycardia recurrence compared with the CA group.