Cryoablation for Ventricular Tachycardia Originating from Anterior Papillary Muscle of Left Ventricle Guided by Intracardiac Echocardiography

Figures

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  Figure 1. ECG showing spontaneous subtle change in QRS morphology after induction of ventricular tachycardia. The first beat () of tachycardia resembles the clinical VT. The second beat () of tachycardia and the rest of beats have the same pattern but with subtle difference indicating most probably different exit point from the papillary muscle.

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  Figure 2. Fluoroscopy showing the position of cryocatheter at anterior papillary muscle in RAO projection.

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  Figure 3. (a) Intracardiac electrogram showing bipolar prepotential preceding the surface QRS by 35 milliseconds (arrow) and unipolar QS pattern (asterisk) recorded at the ablation site during ventricular tachycardia. (b) Programmed stimulation during cryoenergy application did not induce ventricular arrhythmia. The noise in the ablation channel (ABL) is due to ice artifact.

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  Figure 4. (a) Intracardiac echocardiography showing the tip of the catheter at the anterior side of anterior papillary muscle. (b) Intracardiac echocardiography showing the tip of the catheter at the posterior side of anterior papillary muscle. Ice formation is shown at the tip of cryocatheter during cryoenergy application.