Radiofrequency ablation of ventricular tachycardia originating from a lipomatous hamartoma localized in the right ventricle cavity

Figures

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  Figure 1. Images of right ventricular hamartomas. A: Coronal image of cardiac spiral 2-dimensional computed tomography. B: Axial image of cardiac spiral 2-dimensional computed tomography. C: Three-dimensional CARTO composite image. The right ventricular hamartoma in the upper side of the ventricular septum (4.7 cm × 4.7 cm × 7 cm) extended upward to the level of the pulmonary trunk and partially grew into the right ventricle cavity. The left ventricular cavity, parts of the aorta and outflow tract, and valve region of the pulmonary artery were slightly compressed.

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  Figure 2. Twelve-lead electrocardiogram of (A) premature ventricular contraction (PVC)-1 and PVC-2; (B) induced ventricular tachycardia (VT)-1 transforming to VT-2; and (C) recorded clinical VT. PVC-1, PVC-2, and clinical VT occurred spontaneously; VT-1 and VT-2 could be induced and transformed between each other. The morphology of PVC-1 and VT-1 is similar, with a left bundle branch block, inferior axis morphology consistent with a site of origin (SOO) in the right ventricular outflow tract. The morphology of PVC-2 and VT-2 is consistent with SOO from the left ventricular outflow tract or left ventricular free wall and the >160 ms width of QRS suggests an epicardial circuit. VT-2 is similar in morphology to the clinical VT.

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  Figure 3. A: Pace and activation mapping of premature ventricular contraction (PVC)-1. B: CARTO image of PVC-1 and ventricular tachycardia (VT)-1 (with activation map in right panel); PVC-1 (brown tags) and VT-1 (pink tags) shared adjacent site of origin (SOO) in the anteroseptal right ventricular outflow tract. PVC-1 had -37 ms local activation time (LAT) at SOO with 11/12 electrocardiogram pace-map match. VT-1 had -52 ms LAT with QS unipolar morphology at SOO. A linear ablation line of 1 cm was created between the SOO for PVC-1 and VT-1. C: Pace and activation mapping of VT-2. D: CARTO and fluoroscopic images of PVC-2 and VT-2. LAT was only -20 to 30 ms over a diffuse area in the left ventricular anterior free wall, but pace mapping revealed a reasonable enough similarity to VT-2 (C) that a 2-cm T-shaped linear ablation line (arrow) was created at what was suspected of being an area of endocardial breakthrough for VT-2.

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  Figure S1. Twelve-lead electrocardiographic analysis of ventricular tachycardia (VT-2). The continuous and tiny changes of morphologies in leads V1–V6 indicated the slight changes of endocardial conduction exits.

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  Figure S2. Ablation termination of ventricular tachycardia (VT-2).