Subcutaneous ICD Implantation and Catheter Ablation

Figures

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  Figure 1. Baseline 12-Lead Electrocardiogram The tracings show inverted T waves in leads V1 to V2.

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  Figure 2. Results of Programmed Ventricular Stimulation Multiple induced (A and B) monomorphic or (C) polymorphic nonsustained ventricular tachycardias with left bundle branch block configuration and different axis deviation.

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  Figure 3. Endocardial Electroanatomical Map and Intracardiac Recordings (A to D) Electroanatomical mapping and recording. (A) A right ventricular bipolar endocardial electroanatomical map (EAM) shows a region (surface 19.6 cm2) of abnormal voltages consistent with dense scar (≤0.5 mV) (red) and a border zone (0.5-1.5 mV) (yellow to blue) located at the anterior aspect of the outflow tract. Within this area, (C) far-field late potentials were recorded (blue arrows), and (D) ventricular pacing resulted in local ventricular capture (short-stimulus QRS interval) without late potential capture, thus confirming their remote origin (from epicardium). (B) The right ventricular unipolar endocardial substrate map shows a more extensive epicardial scar (53.2 cm2). The right bundle branch block pattern in C was mechanically induced. LAO = left anterior oblique; RVA = right ventricular apex; SITE = mapping catheter.

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  Figure 4. Monomorphic Sustained Ventricular Tachycardia Successfully Treated by Subcutaneous Implantable Cardioverter-Defibrillator Shock

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  Figure 5. Epicardial Substrate Map (A) The bipolar map shows an extensive abnormal voltage area (<1 mV) (red to blue) mirroring in location that detected at the endocardial electroanatomical map (Figure 3D). (B) The right ventricular activation map during sinus rhythm demonstrates a centripetal gradient of delayed activation (red to purple) within the abnormal voltage area. (C) Ablation sites shown by red dots. (D) Examples of single or multicomponent late potentials (arrows) with different activation delays recorded during sinus rhythm within the abnormal substrate. The vertical lines indicate the end of the QRS complex. (E) Electrical stimulation from this area results in direct late potential capture with a prolonged-stimulus QRS interval (see also text). HBE = His bundle electrogram; RVA = right ventricular apex; SITE = ablation catheter.