Electroanatomic visualization of reentrant circuit of left fascicular ventricular tachycardia guiding a fluoroless ablation

Figures

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  Figure 1. Twelve-lead electrocardiogram of the spontaneous clinical ventricular tachycardia, showing wide QRS tachycardia (QRS 120 ms) at 150 beats/min with right bundle branch block and left anterior fascicle block morphology.

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  Figure 2. A: Rest 12-lead electrocardiogram (ECG) with sinus rhythm and ECG recording of the induced ventricular tachycardia during electrophysiological study (the same ECG leads in the right and left subpanels are displayed). B: Three-dimensional activation map of the left ventricle during clinical ventricular tachycardia, showing the entrance site (anterobasal septum, white arrow) and exit site (posteroapical septum, red arrow) of the reentrant circuit.

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  Figure 3. Electroendocardial recordings during ventricular tachycardia. Through the high-density mapping catheter (PentaRay; Biosense Webster) a diastolic Purkinje potential (P1; light blue star) could be recorded at a small area in the middle of the left ventricular septum, with a proximal (basal)-to-distal (apical) activation, toward the presystolic Purkinje potential (P2; red star). Red line indicates radiofrequency ablation line.

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  Supplemental Figure 1. Electroanatomic map of the left ventricle showing target sites where radiofrequency catheter ablation lesions where delivered (red and gray dots = radiofrequency ablation lesions).