1/35. Radiofrequency catheter ablation of coexistent atrioventricular reciprocating tachycardia and left ventricular tachycardia originating in the left anterior fascicle.Coexistence of supraventricular tachycardia and ventricular tachycardia is rare. A patient with no structural heart disease and wide QRS complex tachycardia with a right bundle block configuration and right-axis deviation underwent electrophysiological examination. A concealed left atrioventricular pathway (AP) was found, and atrioventricular reciprocating tachycardia (AVRT) and left ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left ventricle were both induced. Radiofrequency (RF) catheter ablation of the concealed left AP was successfully performed. Ten months later, VT recurred and was successfully ablated using a local Purkinje potential as a guide. Coexistent AVRT and idiopathic VT originating from within or near the left anterior fascicle were successfully ablated.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/35. Radiofrequency catheter ablation of idiopathic right ventricular tachycardia near the His bundle.There are only a few reports on successful radiofrequency catheter ablation of idiopathic right ventricular tachycardia (VT) originating from other sites than right ventricular outflow tract. We report here a case of VT which exhibited an inferior-axis and a left bundle branch block pattern and originated near the His bundle. Using the temperature-controlled ablation catheter, prudent observation of the fluoroscopy and intracardiac electrograms during pacemapping, we successfully ablated the origin of the VT without any conduction disturbance. However, further study is required to determine the effectiveness of catheter ablation and the long term prognosis for this type of VT.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
3/35. Transient local changes in right ventricular monophasic action potentials due to ajmaline in a patient with brugada syndrome.A 48-year-old patient with recurrent episodes of palpitations and syncope presented with transient ST segment elevation in the right precordial ECG leads. Structural heart disease was excluded. No arrhythmias were inducible by programmed ventricular stimulation. Parallel to ST elevation after intravenous ajmaline, a gradual and reversible delay in the upstroke of right ventricular (RV) monophasic action potentials (maps) occurred that was most marked in the RV outflow tract and nearly absent at right free-wall recordings. ajmaline led to a cycle length-dependent increase in RV dispersion of repolarization. Thus, right endocardial maps may demonstrate regionally different action potential changes that may contribute to the ECG changes in brugada syndrome.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/35. catheter ablation of mitral isthmus ventricular tachycardia using electroanatomically guided linear lesions.Mitral isthmus ventricular tachycardia uses a reentrant circuit with a critical isthmus of conduction bounded by the mitral valve proximally and a remote inferior infarction scar distally. Successful catheter ablation requires placement of a lesion to transect the isthmus so as to prevent wavefront propagation. We report a case with previously unsuccessful ablation in which focal isthmus ablation failed to eliminate arrhythmia. Electroanatomic mapping demonstrated a wide tachycardia isthmus, and a linear lesion placed from the edge of the inferior infarct (as demonstrated on the three-dimensional voltage electroanatomic map) to the base of the mitral valve successfully eliminated tachycardia. In some patients with mitral isthmus VT, a wide isthmus requires linear lesion placement to fully transect the isthmus and eliminate tachycardia. Electroanatomic mapping can be used to define isthmus boundaries and thus guide successful ablation.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
5/35. Surgical resection of an intracardiac rhabdomyoma.There are only a few previous reports of intracardiac rhabdomyomas causing ventricular arrhythmias and near syncope. In this report we describe the successful surgical resection of an intracardiac rhabdomyoma using cardiopulmonary bypass, blood cardioplegia, and hypothermia. Preoperative evaluation consisting of echocardiography, computed tomography (CT), magnet resonance imaging (MRI), and positron emission tomography (PET) strongly suggested the presence of a symptomatic primary cardiac tumor projecting from the interventricular septum into the right ventricle.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/35. Hypoglycemic syncope induced by a combination of cibenzoline and angiotensin converting enzyme inhibitor.A 65-year-old Japanese woman with dilated cardiomyopathy, hypothyroidism and refractory sustained ventricular tachycardia experienced a near-death hypoglycemic syncope. The attack seemed to be induced by a high level of serum insulin, probably due to cibenzoline and by concomitant use of an angiotensin converting enzyme inhibitor (ACEI). Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition. This case warns cardiologists that a combined cibenzoline and ACEI therapy can provoke serious adverse effects such as hypoglycemic syncope in the elderly. Therefore, the possibility of a hypoglycemic attack associated with these drugs should be explained to patients who are in poor condition.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/35. The use of echocardiographic colour kinetic wall motion to differentiate broad complex tachycardia.Discrimination between supraventricular tachycardia (SVT) with aberrant conduction from ventricular tachycardia (VT) is vital for the safe and effective management of both conditions. Electrocardiographic algorithms for the differentiation of broad complex tachycardia are complex and difficult to implement in the acute setting, with misdiagnosis occurring in up to 40% of acute presentations. This case study shows the potential for echocardiographic colour kinesis (eck) to support electrocardiographic differentiation. A 74-year old man in sinus rhythm with left bundle branch block (lbbb), a history of myocardial infarction and recurrent sustained VT underwent eck analysis of wall motion propagation during a programmed electrical ventricular stimulation study. Sequential 40 ms time frames of echocardiographic colour coded endocardial wall motion velocity were recorded on video during both induced VT of lbbb configuration and near isochronic atrially paced tachycardia in lbbb. During VT there was initial eck propagation of ventricular septal wall motion from the apex to the atria secondary to electrical depolarisation. During atrially paced tachycardia initial eck motion developed in the interatrial septum and atrial wall followed by propagation in the ventricular endocardial septal wall motion from the atria toward the ventricular apex. This eck technique potentially could be used to support the electrocardiographic diagnosis of a broad complex tachycardia.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/35. Histopathological correlation of ablation lesions guided by noncontact mapping in a patient with peripartum cardiomyopathy and ventricular tachycardia.A patient with peripartum cardiomyopathy developed a nearly incessant nonsustained VT. Guided by a noncontact mapping system, the tachycardia was mapped to the mid-septum of the right ventricle and ablated. Despite transient success, the tachycardia recurred and the patient subsequently died of multiorgan failure. Histopathological correlation of the ablation site revealed a nontransmural lesion that may have contributed to the failure of the ablation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/35. Human pathologic validation of left ventricular linear lesion formation guided by noncontact mapping.This case report describes the histopathologic findings associated with two left ventricular, linear radiofrequency lesions in a patient who underwent cardiac transplantation shortly after an ablation procedure for ventricular tachycardia. The lesions were created with conventional ablation equipment guided by a noncontact mapping system. The findings provide pathologic validation that continuous, linear lesions are feasible using a noncontact mapping system for guidance.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
10/35. Coronary no-flow and ventricular tachycardia associated with habitual marijuana use.A 34-year-old man reported heart fluttering and near syncope a few hours after marijuana smoking. In the emergency department, he was found to have a right bundle-branch-type ventricular tachycardia. The patient underwent a successful electric cardioversion. coronary angiography showed no pericardial artery stenosis yet very slow coronary blood flow. Clinical tachycardia was also inducible in the electrophysiologic laboratory. After verapamil therapy and cessation of marijuana, his coronary flow normalized and ventricular tachycardia was no longer inducible in the electrophysiologic laboratory. Marijuana use might affect coronary microcirculation and cause ventricular tachycardia. verapamil therapy and cessation of smoking might be curative.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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