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Case presentation

Case presentation . By John Kamel Zarif lecturer of cardiology Ain -Shams university . 61 years old male patient, diabetic, hypertensive, ex-smoker. 10 years ago, he suffered from an anteroseptal MI with no reperfusion therapy had been taken.

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Case presentation

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  1. Case presentation By John KamelZarif lecturer of cardiology Ain-Shams university

  2. 61 years old male patient, diabetic, hypertensive, ex-smoker. • 10 years ago, he suffered from an anteroseptal MI with no reperfusion therapy had been taken. • Because of syncopal attack in feb2008, thalium cardiac scan was done which revealed a moderate sized scar in anteroseptal region with no residual viability and minimal peri-infarct ischemia

  3. ECHOcardiography • Mildly dilated LV (60X43) • Fair LV systolic function, EF = 47% • Akinesia of all apical segments, mid septum, mid anterior wall with starting apical aneurysm • coronary angiography was done which revealed non-significant LAD lesion

  4. May2008, he suffered from one attack of documented VT which was haemodynamically stable and he had received DC cardioversion. • He was kept on amiodarone therapy. • Feb2010, another 2 attacks of stable VT had occurred inspite of antiarrhythmic drugs, DC cardioversion were done twice. • Mar2010, ICD implanted • He received 19 ICD Shocks in one month for frequent recurrent VT inspite of good treatment and no correctable causes. • So He was refereed for trial of substrate ablation or modification

  5. Resting ECG

  6. Clinical tachycardia

  7. Induction of clinical tachycardia

  8. Intracardiac tracing of VT

  9. Voltage map

  10. Activation map showing an Early potential

  11. Activation map showing a late potential

  12. Diastolic potentials

  13. Entrainment mapping with 12/12 pacemap

  14. DP-QRS interval

  15. DP-QRS = S-QRS

  16. Return cycle length after entrainment

  17. During ablation

  18. VT2 VT1

  19. VT2 VT1

  20. Diastolic potentials And DP-QRS interval

  21. Entrainment mapping with 12/12 pacemap

  22. DP-QRS = S-QRS

  23. Return cycle length after entrainment

  24. During ablation

  25. FAST VT

  26. Total procedure time: 3 hours • Fluoroscopy time: 60 min • Complication: none

  27. Take home message • Ablation of scar related VT is feasible in the era of 3D CARTO mapping system with more than 70% success rate. • Catheter ablation is indicated as adjunctive therapy in patients with structural heart disease and an ICD who are receiving multiple shocks as a result of sustained VT that is not manageable by reprogramming or changing drug therapy or who don’t wish long tem drug therapy( class I, level of evidence: C) • Combination of entrainment map with activation map  • Increases the effectiveness of ablation. • Decreases the complications of unwanted ablation lesions

  28. Thank you

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