Hydrodissection for pericardial adhesion in percutaneous epicardial ventricular tachycardia ablation

Figures

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  FIGURE 1. Fluoroscopic image showing the lack of contrast spread after attempted blunt dissection with the guide wire. This indicates significant pericardial adhesions preventing the guide wire from advancing. AP, Anterior–posterior view; LR, left–right view.

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  FIGURE 2. Fluoroscopic image after successful dissection of the pericardial adhesions. After hydrodissection, dissection of the adhesions was performed using a catheter, and finally, the HD grid was inserted for mapping. RAO, right anterior oblique view; LAO, left anterior oblique view.

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  FIGURE 3. Electrogram showing long diastolic potentials covering the entire VT diastolic phase observed during VT. These potentials indicate the critical isthmus involved in the central isthmus of the reentry circuit. Due to the presence of a mechanical MV in this patient, the endocardial geometry of the left ventricular basal area is limited. The expected position of the mitral valve is indicated schematically in the figure to compensate for this limitation. Ao, aorta; Endo, endocardium; Epi, epicardium; MV, mitral valves; VT, ventricular tachycardia.

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  FIGURE 4. Electrogram showing concealed entrainment with an S‐QRS/VTCL ratio of 40% observed at the slow conduction area. This finding confirms the site of slow conduction within the reentry circuit (central isthmus). CS, coronary sinus; HDG, HD grid; PCL, pacing cycle length; PPI, post‐pacing interval; S‐QRS, stimulus‐QRS time; VTCL, ventricular tachycardia cycle length.