Refractory Ventricular Tachycardia Originating From an Intracardiac Metastasis Treated With Catheter Ablation

Figures

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  Figure 1. Electrocardiogram and Fluorodeoxyglucose-Positron Emission Tomography Imaging (A) Electrocardiogram of pleomorphic ventricular tachycardia salvos and baseline rhythm. (B) Fluorodeoxyglucose positron emission tomography. Coronal, sagittal, and axial views demonstrating multiple hypermetabolic lesions in liver, axillary ganglion, periaortic and right ventricular free wall (green arrows).

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  Figure 2. Views of Right Ventricular Tumor With Intracardiac Echocardiography (A) Heterogenous and echogenic tumor on the endocardial surface (asterisk). (B) Anatomic relationship of the tumor encasing the moderator band (MB). (C) Radiofrequency lesion applied on the tumor surface at the successful termination site with increased echogenicity during ablation (Abl). RA = right atrium; RV = right ventricle; TV = tricuspid valve.

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  Figure 3. Activation Map and RF Ablation (A) Activation map with a focal breakout pattern originating from the right ventricular free wall tumor location. (B) Early signal −39 ms before QRS complex onset recorded on the tumor surface. (C) Rapid termination of ventricular tachycardia in 5 s during radiofrequency (RF) application.

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  Figure 4. ICE and Histopathologic Images (A) Intracardiac echocardiography (ICE) images during biopsy; the tumor (asterisk) and biopsy forceps (arrow) are visible. (B) Spindle cell tumor (original magnification ×100). (C) Tumor focally positive for S100. Ao = aorta; IVS = interventricular septum; LV = left ventricle; RA = right atrium; RV = right ventricle.