Key Points
- To identify the electrophysiological mechanism and target ablation site for ventricular tachycardia presenting with discordant endocardial and epicardial activation patterns in arrhythmogenic right ventricular cardiomyopathy.
- Performed electroanatomical mapping of both the endocardial and epicardial surfaces during ventricular tachycardia in a 55-year-old male with arrhythmogenic right ventricular cardiomyopathy.
- Delivered radiofrequency catheter ablation targeting the identified critical arrhythmia circuit.
- Endocardial electroanatomical mapping exhibited centrifugal activation originating focally from a low-voltage region in the left ventricular septum.
- Epicardial mapping identified the actual macro-reentrant circuit, and radiofrequency application at an inferior peritricuspid annular site terminated the tachycardia.
- Electrical wavefronts traversed right ventricular epicardial scar before breaking out remotely onto the left ventricular endocardium.
Structured PICO
PPopulationA 55-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT)
IInterventionCatheter ablation with endocardial and epicardial mapping
OOutcomeSuccessful catheter ablation of the ventricular tachycardia
Highlights the importance of epicardial mapping in ARVC patients with VT, as epicardial macro-reentrant circuits can present with misleading focal endocardial activation patterns.