Case presentation <br />By<br />John KamelZarif<br />lecturer of cardiology<br />Ain-Shams university <br />
61 years old male patient, diabetic, hypertensive, ex-smoker.<br />10 years ago, he suffered from an anteroseptal MI with ...
ECHOcardiography<br />Mildly dilated LV (60X43)<br />Fair LV systolic function, EF = 47%<br />Akinesia of all apical segme...
May2008, he suffered from one attack of documented VT which was haemodynamically stable and he had received DC cardioversi...
Resting ECG<br />
Clinical tachycardia<br />
Induction of clinical tachycardia<br />
Intracardiac tracing of VT<br />
Voltage map <br />
Activation map showing an Early potential<br />
Activation map showing a late potential <br />
Diastolic potentials <br />
Entrainment mapping with 12/12 pacemap<br />
DP-QRS interval<br />
DP-QRS = S-QRS<br />
Return cycle length after entrainment<br />
During ablation <br />
        VT2                             VT1<br />
VT2<br />VT1<br />
Diastolic potentials And DP-QRS interval <br />
Entrainment mapping with 12/12 pacemap<br />
DP-QRS = S-QRS<br />
Return cycle length after entrainment<br />
During ablation<br />
FAST VT<br />
Total procedure time: 3 hours<br />Fluoroscopy time: 60 min <br />Complication: none <br />
Take home message <br />Ablation of scar related VT is feasible in the era of 3D CARTO mapping system with more than 70% s...
Decreases the complications of unwanted ablation lesions  </li></li></ul><li>Thank you<br />
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CASE 1.pptx - Case presentation

  1. 1. Case presentation <br />By<br />John KamelZarif<br />lecturer of cardiology<br />Ain-Shams university <br />
  2. 2. 61 years old male patient, diabetic, hypertensive, ex-smoker.<br />10 years ago, he suffered from an anteroseptal MI with no reperfusion therapy had been taken.<br />Because of syncopal attack in feb2008, thalium cardiac scan was done which revealed a moderate sized scar in anteroseptal region with no residual viability and minimal peri-infarct ischemia<br />
  3. 3. ECHOcardiography<br />Mildly dilated LV (60X43)<br />Fair LV systolic function, EF = 47%<br />Akinesia of all apical segments, mid septum, mid anterior wall with starting apical aneurysm <br />coronary angiography was done which revealed non-significant LAD lesion <br />
  4. 4. May2008, he suffered from one attack of documented VT which was haemodynamically stable and he had received DC cardioversion.<br />He was kept on amiodarone therapy.<br />Feb2010, another 2 attacks of stable VT had occurred inspite of antiarrhythmic drugs, DC cardioversion were done twice.<br />Mar2010, ICD implanted<br />He received 19 ICD Shocks in one month for frequent recurrent VT inspite of good treatment and no correctable causes.<br />So He was refereed for trial of substrate ablation or modification <br />
  5. 5. Resting ECG<br />
  6. 6. Clinical tachycardia<br />
  7. 7. Induction of clinical tachycardia<br />
  8. 8. Intracardiac tracing of VT<br />
  9. 9. Voltage map <br />
  10. 10. Activation map showing an Early potential<br />
  11. 11. Activation map showing a late potential <br />
  12. 12. Diastolic potentials <br />
  13. 13. Entrainment mapping with 12/12 pacemap<br />
  14. 14. DP-QRS interval<br />
  15. 15. DP-QRS = S-QRS<br />
  16. 16. Return cycle length after entrainment<br />
  17. 17. During ablation <br />
  18. 18.
  19. 19. VT2 VT1<br />
  20. 20. VT2<br />VT1<br />
  21. 21.
  22. 22. Diastolic potentials And DP-QRS interval <br />
  23. 23. Entrainment mapping with 12/12 pacemap<br />
  24. 24. DP-QRS = S-QRS<br />
  25. 25. Return cycle length after entrainment<br />
  26. 26. During ablation<br />
  27. 27. FAST VT<br />
  28. 28. Total procedure time: 3 hours<br />Fluoroscopy time: 60 min <br />Complication: none <br />
  29. 29. Take home message <br />Ablation of scar related VT is feasible in the era of 3D CARTO mapping system with more than 70% success rate.<br />Catheter ablation is indicated as adjunctive therapy in patients with structural heart disease and an ICD who are receiving multiple shocks as a result of sustained VT that is not manageable by reprogramming or changing drug therapy or who don’t wish long tem drug therapy( class I, level of evidence: C)<br />Combination of entrainment map with activation map  <br /><ul><li>Increases the effectiveness of ablation.
  30. 30. Decreases the complications of unwanted ablation lesions </li></li></ul><li>Thank you<br />
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