The Hidden Scars of Arrhythmogenic (Right Ventricular) Cardiomyopathy

Figures

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  Figure 1. ECG of the Wide Complex Tachycardia Recorded at Presentation to the Emergency Department

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  Figure 2. Resting ECG Recorded During the Hospitalization

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  Figure 3. Endocardial Omnipolar and Unipolar 3-Dimensional Electroanatomical Voltage Maps of the Right Ventricle Obtained in Sinus Rhythm (A) Right anterior oblique (left panel) and left anterior oblique (right panel) views of endocardial omnipolar 3-dimensional electroanatomical voltage map of the right ventricle obtained in sinus rhythm (0.1-1 mV), demonstrating low-voltage areas (nonpurple regions). The omnipolar technology is a novel mapping tool used to acquire omnipolar signals by integrating signals of 3 adjacent electrodes (a clique of 3) that are organized in a triangular pattern. Using the HD Grid mapping catheter, omnipolar maps display a higher resolution compared with standard bipole and HD wave maps. (B) Right anterior oblique (left panel) and left anterior oblique (right panel) views of endocardial unipolar 3-dimensional electroanatomical voltage map of the right ventricle obtained in sinus rhythm (1-5.5 mV), demonstrating extensive low-voltage areas. A combination of low unipolar and low omnipolar voltage is more indicative of true low-voltage areas.

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  Figure 4. Endocardial and Epicardial 3-Dimensional Electroanatomical Maps of the Right Ventricle Obtained in Sinus Rhythm With Demonstration of Ablation Sites (A) Right anterior oblique (left panel) and right anterior oblique caudal (right panel) views of right ventricular endocardial omnipolar 3-dimensional electroanatomical voltage map obtained in sinus rhythm (0.1-1 mV), with demonstration of endocardial ablation sites (red dots). (B) Right ventricular epicardial 3-dimensional electroanatomical voltage (left panel) and isochronal late activation maps (right panel) during sinus rhythm with demonstration of epicardial ablation sites (red dots).