Successful ventricular fibrillation functional substrate ablation via a single vascular access site

Figures

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  Figure 1. Limited vascular access owing to severe peripheral vascular disease and deep venous thromboses status post inferior vena cava filter (noted by the asterisk) depicted in the right (A) and left (B) femoral venograms. C: Right femoral arteriogram shows occlusion owing to severe peripheral arterial disease. Arrows depict the occluded vessels in A–C. An occluded superior vena cava with collateral veins was also observed (not shown for brevity). D: Mapping was accomplished via retrograde aortic insertion of a 60-mm basket catheter into the left ventricle via the left common femoral artery.

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  Figure 2. Ventricular fibrillation (VF) rotor substrate ablation in a 68-year-old man with ischemic cardiomyopathy. A: VF was easily inducible with double extrastimulus pacing at cycle length 500/280/260 ms, as shown on electrocardiography. VF substrate mapping with a single basket catheter in the left ventricle demonstrated a mid posteroseptal rotor, as represented by an isochronal map (B) with activation spanning the entire cycle length of 230 ms. C: A bipolar electroanatomical map shows significant scar burden, with arrows depicting the 3 identified rotor substrate sites with ablation lesions (white dots). Areas of late potentials were incidentally seen both next to ablated tissue at the rotor sites and in border zone tissue remote from the rotor sites (black asterisks).