Top

Published in:

01-11-2011 | Case Report

Electrical storm originating from a left ventricular epicardial scar in a patient with completely normal endocardial voltage

Authors: Eduardo Back Sternick, Christopher Piorkowski, Gerhard Hindricks, Nikolaos Dagres, Philipp Sommer

Published in: Heart and Vessels | Issue 6/2011

Abstract

We report a patient with non-ischemic dilated cardiomyopathy presenting with an electrical storm because of a poorly tolerated monomorphic ventricular tachycardia. Electroanatomical mapping revealed a scar restricted to the epicardium, whereas the endocardial voltage map was completely normal. Epicardial catheter ablation based on substrate mapping and limited pace and entrainment mapping eliminated the tachycardia.

Takahashi A, Shiga T, Shoda M, Tanizaki K, Manaka T, Ejima K, Kasanuki H, Hagiwara N (2010) Gender difference in arrhythmic occurrences in patients with nonischemic dilated cardiomyopathy and implantable cardioverter-defibrillator. Heart Vessels 25:150–154PubMedCrossRef

Sakamoto T, Fujiki A, Nakatani Y, Sakabe M, Mizumaki K, Inoue H (2010) Narrow QRS ventricular tachycardia from the posterior mitral annulus without involvement of the His-Purkinje system in a patient with prior inferior myocardial infarction. Heart Vessels 25:170–173PubMedCrossRef

Sosa E, Scanavacca M, d′Ávila A, Oliveira F, Ramires JA (2000) Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 35:1442–1449PubMedCrossRef

Stevenson WG, Soejima K (2007) Catheter ablation for ventricular tachycardia. Circulation 115:2750–2760PubMedCrossRef

Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Della Bella P, Hindricks G, Jaïs P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D (2009) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias. Heart Rhythm 6:886–933PubMedCrossRef

Lazaros G, Anastasakis A, Tsiachris D, Dilaveris P, Protonotarios N, Stefanadis C (2009) Naxos disease presenting with ventricular tachycardia and troponin elevation. Heart Vessels 24:63–65PubMedCrossRef

Bazan V, Gerstenfeld EP, Garcia FC, Bala R, Rivas N, Dixit S, Zado E, Callans DJ, Marchlinski FE (2007) Site-specific twelve-lead ECG features to identify an epicardial origin for left ventricular tachycardia in the absence of myocardial infarction. Heart Rhythm 4:1403–1410PubMedCrossRef

Vallès E, Bazan V, Marchlinski FE (2010) ECG criteria to identify epicardial ventricular tachycardia in nonischemic cardiomyopathy. Circ Arrhythm Electrophysiol 3:63–71PubMedCrossRef

Arenal A, del Castillo S, Gonzalez-Torrecilla E, Atienza F, Ortiz M, Jimenez J, Puchol A, Garcia J, Almendral J (2004) Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition. Circulation 110:2568–2574PubMedCrossRef

10.

d′Ávila A, Scanavacca M, Sosa E (2006) Transthoracic epicardial catheter ablation of ventricular tachycardia. Heart Rhythm 3:1110–1111PubMedCrossRef

11.

Sosa E, Scanavacca M (2007) Percutaneous pericardial access for mapping and ablation of epicardial ventricular tachycardias. Circulation 115:e542–e544PubMedCrossRef

12.

Swarup V, Morton JB, Arruda M, Wilber DJ (2002) Ablation of epicardial macroreentrant ventricular tachycardia associated with idiopathic nonischemic dilated cardiomyopathy by a percutaneous transthoracic approach. J Cardiovasc Electrophysiol 13:1164–1168PubMedCrossRef

13.

Carbucicchio C, Santamaria M, Trevisi N, Maccabelli G, Giraldi F, Fassini G, Riva S, Moltrasio M, Cireddu M, Veglia F, Della Bella P (2008) Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators. Short- and long-term outcomes in a prospective single-center study. Circulation 117:462–469PubMedCrossRef

14.

Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM (2004) Endocardial and epicardial radiofrequency catheter ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol 43:1834–1842PubMedCrossRef

Title: Electrical storm originating from a left ventricular epicardial scar in a patient with completely normal endocardial voltage
Authors: Eduardo Back Sternick
Christopher Piorkowski
Gerhard Hindricks
Nikolaos Dagres
Philipp Sommer
Publication date: 01-11-2011
Publisher: Springer Japan
Published in: Heart and Vessels / Issue 6/2011
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-010-0109-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Electrical storm originating from a left ventricular epicardial scar in a patient with completely normal endocardial voltage

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2011

Role of ischemia-modified albumin in estimating the extent and scope of cardiac ischemia in patients with ST elevation myocardial infarction

Combined effects of irbesartan and carvedilol on expression of tissue factor and tissue factor pathway inhibitor in rats after myocardial infarction

Effects of stent implantation for peripheral pulmonary artery stenosis on pulmonary vascular hemodynamics and right ventricular function in a patient with repaired tetralogy of Fallot

In patients with idiopathic venous thrombosis, interleukin-10 is decreased and related to endothelial dysfunction

Effect of intravascular ultrasound-guided adjuvant high-pressure non-compliant balloon post-dilation after drug-eluting stent implantation

Different effects of isoflavones on vascular function in premenopausal and postmenopausal smokers and nonsmokers: NYMPH study