Epicardial Macro‐Reentrant Ventricular Tachycardia Exhibiting an Endocardial Centrifugal Activation Pattern in a Case with Arrhythmogenic Right Ventricular Cardiomyopathy

• Published in: Journal of cardiovascular electrophysiology Vol. 20; no. 6; pp. 692 - 695
• Main Authors: YAMADA, TAKUMI, PLUMB, VANCE J., TABEREAUX, PAUL B., KAY, G. NEAL
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-06-2009
• Subjects: arrhythmogenic right ventricular cardiomyopathy; Cardiomyopathies - diagnosis; Cardiomyopathies - etiology; Cardiomyopathies - surgery; epicardial; Humans; Male; radiofrequency catheter ablation; reentrant; Tachycardia, Atrioventricular Nodal Reentry - complications; Tachycardia, Atrioventricular Nodal Reentry - diagnosis; Tachycardia, Atrioventricular Nodal Reentry - surgery; Treatment Outcome; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - surgery; ventricular tachycardia
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/j.1540-8167.2008.01395.x

A 55‐year‐old man with arrhythmogenic right ventricular cardiomyopathy underwent catheter ablation of ventricular tachycardia (VT) with left bundle branch block and left superior axis QRS morphology with an early precordial transition. Endocardial mapping during the VT revealed a focal activation pattern from a small region of low voltage in the left ventricular (LV) septum. Despite earliest endocardial activation in the LV septum, epicardial mapping demonstrated a macro‐reentrant circuit with successful catheter ablation at an inferior peritricuspid annular site. Activation from the reentrant circuit propagated through the scar area in the epicardial right ventricle to the remote endocardial LV breakout site.