Successful ablation with ethanol infusion to coronary sinus branch in a case with scar-related ventricular tachycardia with left ventricular epicardial reentrant circuit

Figures

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  Figure 1. A: Intracardiac electrogram on implantable cardioverter-defibrillator recording showed an initiation of ventricular tachycardia with a cycle length of 280 ms. B: Twelve-lead electrocardiogram (ECG) during atrial pacing showed narrow QRS morphology (left). Meanwhile, 12-lead ECG during sustained monomorphic ventricular tachycardia showed wide QRS morphology with right bundle branch block and superior axis (right).

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  Figure 2. A: The unipolar voltage map during sinus rhythm showed an isolated low-voltage area in the basal left ventricular (LV) posterolateral region. B: Pace-map match to the clinical ventricular tachycardia (VT) morphology was not observed at the posterolateral LV site with low voltages on endocardial unipolar voltage map but was obtained within a coronary sinus (CS) branch where the earliest ventricular activation during VT was recorded. C: The earliest ventricular activation during VT recorded within a CS branch is shown by a red asterisk, preceding QRS onset by 30 ms.

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  Figure 3. A: Endocardial ablation in the posterolateral left ventricular region was not successful. B: Ethanol infusion into a posterolateral vein of the coronary sinus (CS) that eliminated an epicardial scar-related ventricular tachycardia circuit produced the ablation lesions, stained by contrast media, as shown by red arrows.