Retrograde coronary venous ethanol ablation of ventricular tachycardia in a patient after aortic valve replacement and failed both radiofrequency ablation and stereotactic radiotherapy

Figures

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  Figure 1. The 12-lead electrocardiogram of all documented ventricular tachycardia (VT) morphologies showed wide QRS complexes with a pseudo-delta wave, inferior axis, and positive concordance in precordial leads with pattern break in lead V2 (VT1–VT3), suggesting epicardial origin. During the last procedure, only VT4 was induced before ablation.

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  Figure 2. Bipolar radiofrequency (RF) ablation setting and substrate delineation before stereotactic body radiation therapy (SBRT). A: Fluoroscopic images of catheter position during bipolar RF energy application in left anterior oblique (LAO) and right anterior oblique (RAO) projection. B: Distance between active (left ventricle) and ground catheter (great cardiac vein) in left lateral (LL) projection is depicted. C: Endocardial 3-dimensional unipolar map displaying anterobasal low-voltage zone (yellow line) that was targeted by SBRT. CS = coronary sinus; LA = left atrium; LV = left ventricle; RV = right ventricle.

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  Figure 3. Retrograde coronary venous ethanol ablation. A: The coronary sinus (CS) angiogram shows 2 septal branches at the angulation between the great cardiac vein (GCV) and anterior interventricular vein (AIV). B: Micro–balloon catheter cannulation of the second septal branch with ethanol injection; mapping wire introduced in the first septal branch. C: Late potentials (LP) were recorded by mapping wire during right ventricular pacing. D: Pace mapping in the first septal branch produced similar morphology to VT4 with a long stimulus-to-QRS interval. LAO = left anterior oblique; LV = left ventricle.