Stepwise ablation strategy for post–myocardial infarction ventricular fibrillation: From arrhythmia suppression to ablation

Figures

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  Figure 1. A: Twelve-lead electrocardiogram showing recurrence of short coupled premature ventricular contractions (PVCs) and ventricular fibrillation (VF) upon pacing interruption during the ablation procedure. This VF episode needed defibrillation. B: Pacing is stopped after placing high-density mapping catheter on the best pace-mapping site. We observe monomorphic PVC recurrence, and early Purkinje potentials are recorded. The earliest one is spotted on Penta 11-12, 102 ms before ventricular exit. We can notice other, less early Purkinje potentials and an activation sequence (red arrow) from Penta 11-12, 3-4, and 1-2.

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  Figure 2. A: Correlation map obtained after pace mapping. The position of the high-density mapping catheter is concomitant with endocavitary recording in Figure 1B. Spots with earliest Purkinje potentials are tagged (green dots) and the previously described activation sequence is shown (black arrow). B: Baseline substrate map of the left ventricle (right ventricle pacing). C: On the left, electrocardiogram (ECG) morphology of the best pace map; to the right, ECG morphology of the trigger premature ventricular contraction.

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  Figure 3. Stepwise catheter ablation strategy. PVC = premature ventricular contraction.