Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction
Lukasz Szumowski, MD, PhD*,*,
Prashanthan Sanders, MBBS, PhD ,
Franciszek Walczak, MD, PhD*,
Mélèze Hocini, MD,
Pierre Jaïs, MD,
Roman Kepski, PhD*,
Ewa Szufladowicz, MD, PhD*,
Piotr Urbanek, MD*,
Pawe Derejko, MD*,
Robert Bodalski, MD* and
Michel Haïssaguerre, MD
* Institute of Cardiology, Warsaw, Poland
Hopital Cardiologique du Haut-Leveque and the Université Victor Segalen Bordeaux II, Bordeaux, France
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Figure 1 Examples of frequent isolated premature beats followed by the initiation of polymorphic ventricular tachycardia.
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Figure 2 Electroanatomic bipolar voltage map of Patient #4 performed during sinus rhythm. The voltage map delineates the region of scar border-zone. Note that the premature beats originating from the Purkinje network are in this border-zone, where successful ablation was performed (brown tags). Purple tags represent sites recording Purkinje potentials in sinus rhythm, and white tags represent fractionated complex electrograms.
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Figure 3 Electroanatomic bipolar voltage and activation map in Patient #3 performed during premature beats. The activation map demonstrates the centrifugal activation from the border-zone of the scar. The voltage map (right panel) delineates the region of scar border-zone. Note that the premature beats originating from the Purkinje network are in this border-zone, where successful ablation was performed (brown tags). Purple tags represents sites recording Purkinje potentials, and white tags represent fractionated complex electrograms.
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Figure 4 Mapping at the site of earliest activity during premature beats. Note that the Purkinje potential (*) precedes the ventricular activation during both sinus rhythm and the premature beat. Also, the width of the premature beat is quite similar to that during sinus rhythm.
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Figure 5 Purkinje potential (*) preceding each beat of tachycardia, suggestive of driving the tachycardia. The morphology of the ventricular complexes, originating from the Purkinje fibers, is changing, suggesting different Purkinje-muscle outbreak.
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Figure 6 Purkinje potential preceding both sinus and premature beats (*). The last beat demonstrates Purkinje to muscle conduction block.
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