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Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract

Takashi Noda, MD, PhD^_*, Wataru Shimizu, MD, PhD^_*,_*, Atsushi Taguchi, MD^_*, Takeshi Aiba, MD, PhD, Kazuhiro Satomi, MD^_*, Kazuhiro Suyama, MD, PhD^_*, Takashi Kurita, MD, PhD^_*, Naohiko Aihara, MD^_* and Shiro Kamakura, MD, PhD^_*

^_* Division of Cardiology, Department of Internal Medicine
Department of Cardiovascular Dynamics, Research Institute, National Cardiovascular Center, Suita, Japan

View larger version (119K): [in a new window]   Figure 1 (A) Initiation of ventricular fibrillation (VF) recorded by a monitoring electrocardiogram in Patient #1. Note that the morphology of QRS complex of the initiating ventricular extrasystole (VE) was identical to that of preceding isolated premature ventricular contractions (*). (B) Non-sustained polymorphic ventricular tachycardia recorded in 12-lead electrocardiogram during hospitalization in Patient #8. The initiating VE showed left bundle branch morphology with inferior axis (*).

View larger version (108K): [in a new window]   Figure 2 Polymorphic changes of the QRS complex on surface electrocardiogram leads I, II, V1, and V5 during rapid pacing in Patient #3. The morphologic changes were induced by rapid pacing from the origin of the target ventricular extrasystole.

View larger version (40K): [in a new window]   Figure 3 (A) Morphology of target ventricular extrasystole (VE) on 12-lead electrocardiogram (ECG); (B) Pace mapping at the ablation site; (C) Simultaneous recordings of surface ECG and endocardial electrograms during the target VE; (D) Catheter position of radiofrequency catheter ablation site in Patient #2. The pace mapping demonstrated close concordance with the QRS morphology of the target VE in all leads. The bipolar endocardial electrogram of the mapping catheter, which was located in the septum of the right ventricular outflow tract, preceded the surface QRS onset of the target VE by 10 ms. Abl = ablation catheter electrogram; LAO = left anterior oblique; RAO = right anterior oblique; uni = unipolar electrogram.