Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report of two cases

Figures

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  Figure 1. A: Twelve-lead electrocardiogram in sinus rhythm shows terminal QRS notching (J-point elevation) in leads II, III, and aVF. B: Epicardial electroanatomic voltage map in sinus rhythm. Sites with delayed potentials in the inferolateral left ventricle are marked with blue spheres. C: Examples of delayed potentials (arrows) recorded at the epicardial sites marked on the electroanatomic map in panel B with blue spheres. Note that timing of these potentials coincides with the terminal QRS notch in leads III and aVF.

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  Figure 2. A: Twelve-lead electrocardiogram of the induced ventricular tachycardia (VT). B: An example of presystolic local electrograms (D3-4) recorded during VT from the epicardial region with delayed potentials in sinus rhythm (marked with blue spheres in Figure 1B). C: Termination of VT with ablation at the site corresponding to D3-4 in panel B.

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  Figure 3. A: Twelve-lead electrocardiogram (ECG) of the clinical ventricular tachycardia. B: Twelve-lead ECG in sinus rhythm shows terminal QRS notching in leads I and aVL (upper panel). Note augmentation of the terminal QRS notching after postextrasystolic pause in lead II (arrows, lower panel). C: Epicardial electroanatomic voltage map demonstrates 2 areas of abnormal electrograms, right ventricular outflow tract and lateral left ventricle (delineated by red ovals), as well as examples of the corresponding local electrograms (arrows). Sites with high-frequency multicomponent electrograms are tagged on the map with blue spheres.