Anatomic approach with bipolar ablation targeting isolated intramural septal substrate of ventricular tachycardia in a nonischemic cardiomyopathy patient

Figures

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  Figure 1. Clinical VT morphology and Intramural late gadolinium enhancement in the superior septal region. A: The 12-lead electrocardiograms of the clinical VT. B: An Image of enhanced cardiac magnetic resonance before the procedure. This shows a full-length septal LGE and isolated intramural LGE in the superior intraseptal region (yellow circle). RV = right ventricle; LV = left ventricle; VT = ventricular tachycardia; LGE = late gadolinium enhancement.

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  Figure 2. An over-the-wire microelectrode catheter in the septal perforator vein recorded a long diastolic potential. A: Coronary venography showed a large septal perforator vein. B: The activation map of the clinical VT. C: The earliest activation on the LV septum was –34 ms from the QRS onset of the VT. A long fractionated diastolic potential was recorded from electrodes 1–2 of the OTW catheter in the septal perforator vein. RV = right ventricle; LV = left ventricle; VT = ventricular tachycardia.

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  Figure 3. Successful anatomic approach with bipolar ablation targeting the late potentials recorded by the over-the-wire microelectrode catheter. A: The catheter position for the bipolar ablation. B: The late potentials recorded on electrodes 1–2 of the OTW catheter were eliminated by multiple bipolar ablation applications.