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Figure 4 The border between the normal and infarcted/aneurysmal wall contains a stylized ventricular tachycardia (VT) circuit—predominantly endocardial, and partially intramural. The surgical procedures, subendocardial resection, and ventriculotomy are believed to either remove or transect critical endocardial portions of the VT circuit, respectively. After mapping the border zone using the electroanatomic mapping system, the putative exit site of the VT was identified with pace-mapping, and catheter-based linear lesions were placed. Although a single catheter-based linear lesion set along the scar border could potentially interrupt the circuit(s), unlike during surgery, one cannot ensure the lesion’s depth and continuity. Therefore, a second linear lesion set was placed proceeding into the scarred myocardium—with the hope that this empiric lesion set would transect critical portions of the VT circuit(s). LV = left ventricular. Figure reproduced and modified with permission, courtesy of J. Miller, MD, and Williams & Wilkins Inc. (19).
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