Nonsurgical transthoracic epicardial radiofrequency ablation
An alternative in incessant ventricular tachycardia
Josep Brugada, MD*,*,
Antonio Berruezo, MD*,
Alejandro Cuesta, MD*,
Joaquin Osca, MD*,
Enrique Chueca, MD*,
Xavier Fosch, MD*,
Luis Wayar, MD* and
Lluis Mont, MD*
* Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Figure 1 Radioscopic anteroposterior view showing a quadripolar diagnostic catheter in the right ventricle and an 8-mm tip ablation catheter in the pericardial space. Note the contrast in the pericardial sac.
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Figure 2 Radioscopic anteroposterior view showing an 8-mm tip ablation catheter in the left ventricle and a 4-mm tip ablation catheter in the pericardial space at the site of failed endocardial ablation and successful epicardial ablation.
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Figure 3 (Top to bottom) 12-lead surface electrocardiograms and two electrograms from the endocardium and epicardium. The signal from the endocardium shows a split potential. Ablation at this site was unsuccessful. From the epicardium, the electrical signal was discrete and had a similar precocity. At this site, ablation was effective.
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Figure 4 (Top to bottom) 12-lead surface electrocardiograms, endocardial signals from the right ventricle, and epicardial signals from the left ventricle corresponding to two different ventricular tachycardias in the same patient. (Left) Epicardial signals show fractionated electrograms of high voltage present during the diastole preceding the QRS complex. (Right) Epicardium signals show an isolated diastolic potential followed by a fractionated electrogram preceding the QRS complex. In these sites, radiofrequency ablation effectively terminated the tachycardia depicted in the 12-lead electrocardiogram.
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Figure 5 (Top to bottom) 12-lead surface electrocardiogram, endocardial signals from the right ventricle, and epicardial signals from the left ventricle. The cycle length of the ventricular tachycardia was 510 ms. Pacing from the epicardium shows concealed entrainment and a return cycle identical to the tachycardia cycle length. Ablation was effective at this site.
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