Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia
Domenico Corrado, MD, PhD*,*,
Cristina Basso, MD, PhD ,
Loira Leoni, MD, PhD*,
Barbara Tokajuk, MD, PhD*,
Pietro Turrini, MD, PhD*,
Barbara Bauce, MD, PhD*,
Federico Migliore, MD*,
Andrea Pavei, MD*,
Giuseppe Tarantini, MD, PhD*,
Massimo Napodano, MD*,
Angelo Ramondo, MD*,
Gianfranco Buja, MD*,
Sabino Iliceto, MD* and
Gaetano Thiene, MD
* Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padua, Italy
Department of Medical-Diagnostic Sciences, University of Padua Medical School, Padua, Italy.
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Figure 1 Electrocardiographic and Histopathological Findings in a Representative Patient From Group A
(A) Right anterior oblique view of the right ventricular (RV) bipolar voltage map showing preserved bipolar voltages values (purple indicates >1.5 mV) throughout the RV. (B) Endomyocardial biopsy sample showing normal myocardium (Heidenhain trichrome x40). (C) 12-lead electrocardiogram during clinically-sustained ventricular tachycardia 170 beats/min, with a left bundle branch block/inferior axis morphology.
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Figure 2 Electrocardiographic and Histopathological Findings in a Representative Patient From Group B
(A) Right anterior oblique view of the right ventricular bipolar voltage map showing a low-amplitude (red indicates <0.5 mV) area in the anteroinfundibular region. (B) Endomyocardial biopsy samples showing fibrofatty replacement (Heidenhain trichrome x40). (C) 12-lead electrocardiogram during clinically-sustained ventricular tachycardia 170 beats/min, with a left bundle branch block/inferior axis morphology.
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Figure 3 3-Dimensional Electroanatomical Maps of the RV in 2 Representative Patients Undergoing Catheter Ablation of RVOT Tachycardia
(Left) Voltage mapping (left anterior oblique [LAO] 60°) showing preserved bipolar electrograms amplitude throughout the right ventricular (RV) free wall and septum in a patient from group A. Red dots indicate the site of successful radiofrequency ablation in the anteroseptal surface of the right ventricular outflow tract (RVOT). (Right) Voltage mapping (right anterior oblique 30°) showing electroanatomical scar regions in the RVOT in a patient from group B. Targeted ventricular tachycardia was no longer inducible only after completion of serial point ablations completely encircling areas of abnormal voltages.
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