Using a multielectrode catheter to facilitate mapping and ablation of idiopathic fascicular ventricular tachycardia

Figures

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  Figure 1. A: The initial tracing from emergency medical services of a 16-year-old patient demonstrating a wide complex tachycardia with a right bundle branch block and superior axis deviation and ventriculoatrial dissociation (circles indicate P waves). B: Intracardiac tracings showing ventriculoatrial dissociation during ventricular tachycardia. (Map catheter in the right ventricle, atrial electrograms with far-field ventricular signals noted in the coronary sinus catheter.)

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  Figure 2. A, B: Right anterior oblique (A) and laterolateral (B) projection of the electroanatomic map during sinus rhythm with the DECANAV catheter (Biosense Webster) placed on the left ventricular septum via retrograde approach. Blue dots indicate Purkinje potentials (P2). Pink dots indicate His bundle electrograms. C: P2 potentials (blue arrows) are clearly visualized along with the proximal His bundle electrograms (pink arrow).

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  Figure 3. A, B: Right anterior oblique (RAO) (A) and laterolateral (LL) (B) projection of the electroanatomic map during fascicular ventricular tachycardia with the DECANAV catheter (Biosense Webster) placed on the left ventricular septum via retrograde approach through the aorta. Blue dots indicate Purkinje potentials (P2), yellow dots indicate pre-Purkinje potentials (P1). C: On the DECANAV catheter, P2 potentials are clearly visualized (blue arrows) and P1 potentials (yellow arrows) are seen as part of double potentials at CS 3–4 and CS 5–6, suggesting the point of turnaround of circuit. D, E: RAO (D) and LL (E) projection of the same map with the radiofrequency ablation lesions as red dots.