This document describes the procedure and methodology for substrate mapping of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) using noncontact mapping with the EnSite array system. Key points include:
- The EnSite array is deployed in the RVOT to create a 3D geometry and reconstruct virtual electrograms.
- The VT origin is defined as the earliest activation site with a QS pattern, and a breakout site is where dV/dt is maximum along the activation pathway.
- Characteristics like earlier activation, steeper negative deflection, and activation timing can differentiate RVOT from non-RVOT VT origins.
- Depth and shape of the origin site can impact activation measurements and
This document describes a case of a 38-year-old male who presented with frequent palpitations. An EKG during tachycardia showed two different P waves. Differential diagnoses included multifocal atrial tachycardia, ventricular tachycardia with AV dissociation, and ventricular tachycardia with retrograde conduction. Laboratory and echo tests were normal with no structural heart disease. Intracardiac recordings showed ventricular electrical activity was predominant with no dual AV node properties and a zero HV interval. Ablation at a site with diastolic potentials successfully terminated the arrhythmia, confirming the diagnosis of idiopathic left ventricular tachycardia.
The document describes a case study of a 59-year-old man with a history of hypertension and smoking who presented with recurrent ventricular tachycardia originating from the left anterior papillary muscle. Through catheter mapping and ablation, the source of the arrhythmia was identified as late potentials near the left anterior papillary muscle, and no further arrhythmias occurred following radiofrequency ablation at this site. The presentation also reviews characteristics of papillary muscle ventricular arrhythmias compared to fascicular arrhythmias.
Idiopathic VT refers to VT occurring in structurally normal hearts in the absence of myocardial scarring. Classification of monomorphic idiopathic VT includes outflow tract VT, fascicular VT, papillary muscle VT,annular VT, and miscellaneous (VT from the body of the RV and crux of
the heart). It is commonly seen in young patients and usually has a benign course. The 12-lead lectrocardiogram is critical in distinguishing the specific form and locations of idiopathic VT. Treatment options include medical therapy specific to the underlying mechanism of VT or catheter
ablation.
1. Outflow tract VT is the most common type of idiopathic VT, accounting for over 60% of cases in the study.
2. Pace mapping alone may not accurately locate ablation sites, especially for VT associated with scar tissue. Activation mapping and substrate identification are important complementary mapping techniques.
3. Successful ablation of substrate-based VT requires targeting abnormal electrograms within scar regions like late potentials or fractionated signals at the critical isthmus.
This document discusses catheter ablation of ventricular tachycardia. It provides statistics on the most common underlying heart conditions associated with VT treated with ablation at a medical center in Taiwan from 2001-2011. These include dilated cardiomyopathy (DCM), coronary artery disease (CAD), and arrhythmogenic right ventricular cardiomyopathy (ARVC). The document reviews techniques for mapping and ablating different types of VT based on underlying etiology and arrhythmia mechanism, such as focal VT originating from the outflow tracts or papillary muscles, and reentrant VT associated with ARVC or substrate-based scar. Long-term outcomes data is presented showing recurrence risks based on ARVC diagnostic criteria and substrate mapping findings.
This document provides an outline for a module on ventricular tachyarrhythmias. It begins with module objectives of differentiating types of ventricular tachycardias using ECGs. The outline then describes ventricular tachyarrhythmias, discusses characteristics like mechanisms and sustained vs nonsustained types. It classifies ventricular tachyarrhythmias as monomorphic or polymorphic, and provides subcategories within each with descriptions and ECG recognition details. Specific arrhythmias discussed include idiopathic VT, bundle branch reentry, ventricular flutter, fibrillation, and Torsades de Pointes.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
This document describes the procedure and methodology for substrate mapping of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) using noncontact mapping with the EnSite array system. Key points include:
- The EnSite array is deployed in the RVOT to create a 3D geometry and reconstruct virtual electrograms.
- The VT origin is defined as the earliest activation site with a QS pattern, and a breakout site is where dV/dt is maximum along the activation pathway.
- Characteristics like earlier activation, steeper negative deflection, and activation timing can differentiate RVOT from non-RVOT VT origins.
- Depth and shape of the origin site can impact activation measurements and
This document describes a case of a 38-year-old male who presented with frequent palpitations. An EKG during tachycardia showed two different P waves. Differential diagnoses included multifocal atrial tachycardia, ventricular tachycardia with AV dissociation, and ventricular tachycardia with retrograde conduction. Laboratory and echo tests were normal with no structural heart disease. Intracardiac recordings showed ventricular electrical activity was predominant with no dual AV node properties and a zero HV interval. Ablation at a site with diastolic potentials successfully terminated the arrhythmia, confirming the diagnosis of idiopathic left ventricular tachycardia.
The document describes a case study of a 59-year-old man with a history of hypertension and smoking who presented with recurrent ventricular tachycardia originating from the left anterior papillary muscle. Through catheter mapping and ablation, the source of the arrhythmia was identified as late potentials near the left anterior papillary muscle, and no further arrhythmias occurred following radiofrequency ablation at this site. The presentation also reviews characteristics of papillary muscle ventricular arrhythmias compared to fascicular arrhythmias.
Idiopathic VT refers to VT occurring in structurally normal hearts in the absence of myocardial scarring. Classification of monomorphic idiopathic VT includes outflow tract VT, fascicular VT, papillary muscle VT,annular VT, and miscellaneous (VT from the body of the RV and crux of
the heart). It is commonly seen in young patients and usually has a benign course. The 12-lead lectrocardiogram is critical in distinguishing the specific form and locations of idiopathic VT. Treatment options include medical therapy specific to the underlying mechanism of VT or catheter
ablation.
1. Outflow tract VT is the most common type of idiopathic VT, accounting for over 60% of cases in the study.
2. Pace mapping alone may not accurately locate ablation sites, especially for VT associated with scar tissue. Activation mapping and substrate identification are important complementary mapping techniques.
3. Successful ablation of substrate-based VT requires targeting abnormal electrograms within scar regions like late potentials or fractionated signals at the critical isthmus.
This document discusses catheter ablation of ventricular tachycardia. It provides statistics on the most common underlying heart conditions associated with VT treated with ablation at a medical center in Taiwan from 2001-2011. These include dilated cardiomyopathy (DCM), coronary artery disease (CAD), and arrhythmogenic right ventricular cardiomyopathy (ARVC). The document reviews techniques for mapping and ablating different types of VT based on underlying etiology and arrhythmia mechanism, such as focal VT originating from the outflow tracts or papillary muscles, and reentrant VT associated with ARVC or substrate-based scar. Long-term outcomes data is presented showing recurrence risks based on ARVC diagnostic criteria and substrate mapping findings.
This document provides an outline for a module on ventricular tachyarrhythmias. It begins with module objectives of differentiating types of ventricular tachycardias using ECGs. The outline then describes ventricular tachyarrhythmias, discusses characteristics like mechanisms and sustained vs nonsustained types. It classifies ventricular tachyarrhythmias as monomorphic or polymorphic, and provides subcategories within each with descriptions and ECG recognition details. Specific arrhythmias discussed include idiopathic VT, bundle branch reentry, ventricular flutter, fibrillation, and Torsades de Pointes.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.
