Refractory hypoxemia from intracardiac shunting following ventricular tachycardia ablation in a patient with a left ventricular assist device

Figures

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  Figure 1. Twelve-lead electrocardiogram showing the patient’s presenting wide complex tachycardia with a ventricular rate of 125 bpm, atrioventricular (AV) dissociation, and QRS morphology consistent with the patient’s dominant ventricular tachycardia.

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  Figure 2. Right anterior oblique projection of 3-dimensional bipolar activation (A) and voltage (B) electroanatomic map of the left ventricular substrate. A: Activation mapping of the inducible ventricular tachycardia demonstrates multiple sites of early activation in the anterior left ventricle near the left ventricular assist device (LVAD) cannula (gray area). B: Voltage mapping demonstrates a large burden of low voltage around the anterior, apical, and inferior areas of the left ventricle and the LVAD cannula. Cyan dots represent complex fractionated electrograms. Green dot identifies the location of the earliest potential. White design line identifies the location of a planned ablation line running from the LVAD cannula to the mitral annulus.

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  Figure 3. Bicaval transesophageal echocardiographic view during clinical decompensation showing continuous right-to-left shunting through an iatrogenic atrial septal defect.