A perfect storm of ventricular fibrillation: Infarct, posterior fascicle, and the moderator band

Figures

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  Figure 1. The clinical premature ventricular contraction (PVC) triggering ventricular fibrillation (VF) (A) had a similar implantable cardioverter-defibrillator (ICD) electrogram far-field morphology as the spontaneous PVC targeted during ablation (B). Pace mapping from the earliest site at the inferoseptal left ventricle (LV) (C) also had similar morphology. The amplitudes of the electrograms were automatically saved differently by the ICD, as noted.

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  Figure 2. A: Twelve-lead electrocardiogram and earliest local activation time (LAT -40 ms) with a Purkinje-like potential of the clinical premature ventricular contraction (PVC), recorded using a multielectrode catheter (high-density grid). B: Biventricular activation map showing origin of the PVC from the inferoseptal left ventricle (LV). C: Bipolar voltage map showing large scar at the inferoseptal LV, with PVC origin directly across the septum from the right ventricular (RV) moderator band.

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  Figure 3. Activation map of the premature ventricular contraction (PVC; left panel) originating from the left ventricular (LV) inferoseptum, just distal to the posteroseptal fascicle, as shown in the activation map of the intrinsic conduction system recorded during sinus rhythm (right panel). Intracardiac electrograms recorded by a multielectrode catheter (high-density grid) show Purkinje-like signals at the earliest site during PVC (arrow, local activation time [LAT] -40 ms) and during sinus rhythm (asterisk, LAT -10 ms).