Epicardial mapping and ablation after stereotactic arrhythmia radioablation for ventricular tachycardia using a novel mapping catheter

Figures

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  Figure 1. A 12-lead electrocardiogram during ventricular tachycardia. The heart rate was 136 beats per minute, and the QRS morphology showed a superior axis and a transitional zone between leads V1 and V2.

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  Figure 2. A: An epicardial voltage map obtained with PENTARAY during the fifth catheter ablation procedure (left lateral view). Late potentials were observed in the basal-lateral left ventricular wall. B: An axial computed tomography scan slice displaying the stereotactic arrhythmia radioablation treatment planning. The substrate of ventricular tachycardia in the basal-lateral left ventricular region received 25 Gy.

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  Figure 3. A: An epicardial voltage map obtained with OPTRELL during the sixth catheter ablation procedure (LL view). Late potentials were identified in the basal-lateral wall of the left ventricle. The epicardial mapping was incomplete in certain regions. In consideration of the patient’s heart failure with reduced ejection fraction, procedural duration was intentionally minimized, which resulted in some mapping gaps. B: An epicardial voltage map (PA view). C: An epicardial voltage map (30-degree RAO view). D: The ablation tags after epicardial ablation (LL view). The ablation mainly targeted a wide area centered on the basal-lateral left ventricle. E: The ablation tags (PA view). F: The ablation tags (30-degree RAO view). LL = left lateral; PA = posteroanterior; RAO = right anterior oblique.