Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction
A patient underwent an electrophysiological study (EPS) and catheter ablation (CA) for ventricular tachycardia (VT) that developed 11 years after myocardial infarction. Entrainment mapping (EM) of the left ventricle did not identify the origin of the VT during induction. Electro-anatomical mapping r...
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doaj-86762751b4004f8dac962201b09df4072020-11-24T23:49:57ZengWileyJournal of Arrhythmia1880-42762007-01-0123215716310.1016/S1880-4276(07)80028-7Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial InfarctionEmi Nakano, MDTomoo Harada, MDKiyoshi Nakazawa, MDKeizou Osada, MDAkihiko Takagi, MDToshio Sasaki, MDKihei Yoneyama, MDHirofumi Wakimoto, MDOsamu Tanaka, MDKouichi Mizuno, MDNobuyuki Azuma, MDRyouji Kishi, MDFumihiko Miyake, MDA patient underwent an electrophysiological study (EPS) and catheter ablation (CA) for ventricular tachycardia (VT) that developed 11 years after myocardial infarction. Entrainment mapping (EM) of the left ventricle did not identify the origin of the VT during induction. Electro-anatomical mapping revealed a low voltage area from the anterior to the inferior left ventricular wall. Another EPS was performed for right ventricular mapping. A basket catheter was placed in the right ventricle to evaluate impulse propagation and we attempted to identify the VT circuit with EM during the same VT (complete left bundle branch block configuration, inferior axis) as the previous EPS. Eight different VT appeared, three of which were sustained during CA. The reentry circuit exit was identified on the tricuspid annulus (TA) at the 9:00 site and radiofrequency (RF) ablation was performed, but the axis transformed from the inferior to the superior and another VT appeared. Despite RF ablation to the VT circuit exit at the 5:00 site, another sustained VT appeared. Finally, it was terminated by ablation to a critical slow conduction zone (SCZ) located near the 7:00 site one year later. Electro-anatomical voltage mapping detected a critical isthmus between TA and right ventricle infarct scar. Here, we describe a rare SCZ proximal to the TA in a patient with VT late after myocardial infarction.http://www.sciencedirect.com/science/article/pii/S1880427607800287Myocardial infarctionVentricular tachycardiaTricuspid annulus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emi Nakano, MD Tomoo Harada, MD Kiyoshi Nakazawa, MD Keizou Osada, MD Akihiko Takagi, MD Toshio Sasaki, MD Kihei Yoneyama, MD Hirofumi Wakimoto, MD Osamu Tanaka, MD Kouichi Mizuno, MD Nobuyuki Azuma, MD Ryouji Kishi, MD Fumihiko Miyake, MD |
spellingShingle |
Emi Nakano, MD Tomoo Harada, MD Kiyoshi Nakazawa, MD Keizou Osada, MD Akihiko Takagi, MD Toshio Sasaki, MD Kihei Yoneyama, MD Hirofumi Wakimoto, MD Osamu Tanaka, MD Kouichi Mizuno, MD Nobuyuki Azuma, MD Ryouji Kishi, MD Fumihiko Miyake, MD Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction Journal of Arrhythmia Myocardial infarction Ventricular tachycardia Tricuspid annulus |
author_facet |
Emi Nakano, MD Tomoo Harada, MD Kiyoshi Nakazawa, MD Keizou Osada, MD Akihiko Takagi, MD Toshio Sasaki, MD Kihei Yoneyama, MD Hirofumi Wakimoto, MD Osamu Tanaka, MD Kouichi Mizuno, MD Nobuyuki Azuma, MD Ryouji Kishi, MD Fumihiko Miyake, MD |
author_sort |
Emi Nakano, MD |
title |
Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction |
title_short |
Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction |
title_full |
Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction |
title_fullStr |
Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction |
title_full_unstemmed |
Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction |
title_sort |
critical slow conduction zone located between the tricuspid annulus and a myocardial infarct scar in a patient with multiple ventricular tachycardia late after myocardial infarction |
publisher |
Wiley |
series |
Journal of Arrhythmia |
issn |
1880-4276 |
publishDate |
2007-01-01 |
description |
A patient underwent an electrophysiological study (EPS) and catheter ablation (CA) for ventricular tachycardia (VT) that developed 11 years after myocardial infarction.
Entrainment mapping (EM) of the left ventricle did not identify the origin of the VT during induction. Electro-anatomical mapping revealed a low voltage area from the anterior to the inferior left ventricular wall. Another EPS was performed for right ventricular mapping.
A basket catheter was placed in the right ventricle to evaluate impulse propagation and we attempted to identify the VT circuit with EM during the same VT (complete left bundle branch block configuration, inferior axis) as the previous EPS.
Eight different VT appeared, three of which were sustained during CA. The reentry circuit exit was identified on the tricuspid annulus (TA) at the 9:00 site and radiofrequency (RF) ablation was performed, but the axis transformed from the inferior to the superior and another VT appeared. Despite RF ablation to the VT circuit exit at the 5:00 site, another sustained VT appeared. Finally, it was terminated by ablation to a critical slow conduction zone (SCZ) located near the 7:00 site one year later. Electro-anatomical voltage mapping detected a critical isthmus between TA and right ventricle infarct scar.
Here, we describe a rare SCZ proximal to the TA in a patient with VT late after myocardial infarction. |
topic |
Myocardial infarction Ventricular tachycardia Tricuspid annulus |
url |
http://www.sciencedirect.com/science/article/pii/S1880427607800287 |
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