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      Intramural Reentrant Ventricular Tachycardia in a Patient with Severe Hypertensive Left Ventricular Hypertrophy

      case-report

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          Abstract

          We describe the case of a patient with severe hypertensive left ventricular hypertrophy and sustained hemodynamically unstable ventricular tachycardia (VT). Entrainment was demonstrated in the electrophysiological study. Activation mapping and pacemapping identified the location of the intramural reentrant VT with the exit site close to the epicardium. However, VT persisted after ablation at the epicardial exit site. Successful ablation was performed endocardially at the corresponding position.

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          Left ventricular hypertrophy: pathogenesis, detection, and prognosis.

          Beverly Lorell, Blase Carabello (2000)
          Article 0 comments Cited 214 times – based on 0 reviews     Review now
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            Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy.

            Edward Gerstenfeld, Brien Riley, Francis Marchlinski … (2011)
            Patients with nonischemic left ventricular cardiomyopathy (LVCM) and ventricular tachycardia (Vt) have complex 3-dimensional substrate with variable involvement of the endocardium (ENDO) and epicardium (EPI). The purpose of this study was to determine whether ENDO unipolar (UNI) mapping with a larger electric field of view could identify EPI low bipolar (BIP) voltage regions in patients with LVCM undergoing Vt ablation. The reference value for normal ENDO unipolar voltage was determined from 6 patients without structural heart disease. Consecutive patients undergoing Vt ablation over an 8-year period with detailed (>100 points) LV ENDO and EPI mapping and normal LV ENDO BIP voltage were identified. From this cohort, we compared patients with structurally normal hearts and normal EPI BIP voltage (EPI-, group 1) with patients with LVCM and low LV EPI BIP voltage regions present (EPI+, group 2). Confluent regions of ENDO UNI and EPI BIP low voltage (>2 cm(2)) were measured. The normal signal amplitude was >8.27 mV for LV ENDO UNI electrograms. Detailed LV ENDO-EPI maps in 5 EPI- patients were compared with 11 EPI+ patients. Confluent ENDO UNI low-voltage regions were seen in 9 of 11 (82%) of the EPI+ (group 2) patients compared with none of 5 EPI- (group 1) patients (P<0.001). In all 9 patients with ENDO UNI low voltage, the ENDO UNI low-voltage regions were directly opposite to an area of EPI BIP low voltage (61% ENDO UNI-EPI BIP low-voltage area overlap). EPI arrhythmia substrate can be reliably identified in most patients with LVCM using ENDO UNI voltage mapping in the absence of ENDO BIP abnormalities.
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              The heart in hypertension.

              E Frohlich, C Apstein, A Chobanian … (1992)
              Article 0 comments Cited 61 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (iso-abbrev): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): November 2015
                Publication date (Electronic): 25 November 2015
                Volume: 45
                Issue: 6
                Pages: 526-530
                Affiliations
                [1 ]Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
                [2 ]Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
                Author notes
                Correspondence: Shih-Ann Chen, MD, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, 11217, R.O.C Taipei, Taiwan. Tel: 886-2-2875-7156, Fax: 886-2-2873-5656, epsachen@ 123456ms41.hinet.net

                *These authors contributed equally to this work.

                Article
                DOI: 10.4070/kcj.2015.45.6.526
                PMC ID: 4661370
                SO-VID: 1d2b5297-9466-4dce-8dbc-4a7ae8d8a51f
                Copyright © Copyright © 2015 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 October 2014
                Date revision received : 11 December 2014
                Date accepted : 17 March 2015
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: catheter ablation,hypertension,hypertrophy, left ventricular,tachycardia, ventricular
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: catheter ablation, hypertension, hypertrophy, left ventricular, tachycardia, ventricular

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