Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy
Nassir F. Marrouche, MD*,
Atul Verma, MD*,
Oussama Wazni, MD*,
Robert Schweikert, MD*,
David O. Martin, MD*,
Walid Saliba, MD*,
Fethi Kilicaslan, MD*,
Jennifer Cummings, MD*,
J. David Burkhardt, MD*,
Mandeep Bhargava, MD*,
Dianna Bash, RN*,
Johannes Brachmann, MD*,
Jens Guenther, MD*,
Steven Hao, MD*,
Salwa Beheiry, RN*,
Antonio Rossillo, MD*,
Antonio Raviele, MD*,
Sakis Themistoclakis, MD* and
Andrea Natale, MD*,*
* Section of Cardiovascular Electrophysiology, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Panels A and B depict electrocardiographic (ECG) strips from one ventricular fibrillation (VF) storm patient who underwent ablation. Panel A shows a monomorphic premature ventricular contraction (PVC) (*) initiating non-sustained polymorphic ventricular tachycardia. Panel B shows the same morphology PVC (*) initiating VF. Panel C depicts surface ECG (I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6) and intracardiac recordings from the ablation catheter (ABLp). The vertical caliper lines on the third beat of the tracing ( ) indicate a high frequency potential preceding the PVC by 70 ms. Similar high-frequency Purkinje-like potentials are also seen during the two sinus beats that precede the PVC (arrows). Similar potentials were seen in patients without spontaneous PVCs along the scar border.
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Figure 2 Three-dimensional voltage CARTO (Biosense-Webster Inc.) map of the left ventricle in a patient who underwent ablation for ventricular fibrillation storm and also had a left ventricular assist device (LVAD). Red regions on the map represent scar, whereas green and blue regions represent abnormal tissue in the scar border zone. Purple indicates normal voltage >1.5 mV. The red circle indicates the site where premature ventricular contractions preceded by high frequency Purkinje-like potentials were mapped and successfully ablated. The ablation site is located along the edge of the scar region in the border zone. MA = mitral annulus.
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