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. 2000 Nov;84(5):553–559. doi: 10.1136/heart.84.5.553

Radiofrequency catheter ablation of ventricular tachycardia

W Stevenson 1, E Delacretaz 1
PMCID: PMC1729484  PMID: 11040021

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Figure 1:  .

Figure 1:  

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Idiopathic right ventricular outflow tract tachycardia. The 12 lead ECG shows tachycardia with a left bundle branch block, configuration and frontal plane axis directed inferiorly. The schematic at the upper right shows the right ventricle viewed from the right anterior oblique position with the free wall of the ventricle folded down. The location of the tachycardia in the right ventricular outflow tract (RVOT) is indicated with an arrow. TV, tricuspid valve; RV, right ventricle.

Figure 2:  .

Figure 2:  

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The mapping data are from a patient with VT late after anterior wall myocardial infarction. Mapping was performed using a system that plots the precise catheter position along with colour coded electrophysiologic information (CARTO Biosense Webster, Diamond Bar, California, USA). The top two panels show the left ventricle in right anterior oblique (RAO) and left lateral views. In this case, colours indicate the electrogram voltage, rather than timing. The lowest voltage regions are shown in red, progressing to greater voltage regions of yellow, green, blue, and purple. A large anteroapical infarction is indicated by the extensive low voltage, red region. The lower right panel shows the map of VT in the same patient. The ventricle is again shown in a right anterior oblique projection with the apex at the right and the base at the left hand side of the image. The colours indicate the activation sequence and arrows have been drawn to clarify the activation sequence of the circuit. The re-entry circuit is located in the septum. The wavefront starts at the red area (exit) near the base of the septum and splits into two loops that circle around the superior and inferior aspect of the septum toward the apex, re-entering an isthmus in the circuit that is proximal to the exit region. RF ablation in the isthmus abolished tachycardia. The mechanism of slow conduction through the infarct region that has been observed in previous histopathologic studies is illustrated schematically in the inset at lower left. Surviving myocyte bundles are separated by fibrous tissue that forces the wavefront to take a circuitous path through the region.

Figure 3:  .

Figure 3:  

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Bundle branch re-entry tachycardia. The left hand panel shows bundle branch re-entry tachycardia initiated in the electrophysiology laboratory. From the top are surface ECG leads and intracardiac recordings from the right atrium (RA) and His bundle position (His). VT has a left bundle branch block configuration and cycle length of 295 ms. Atrioventricular dissociation is evident in the right atrial recording (RA). A His bundle deflection (arrows) precedes each QRS indicating that the His-Purkinje system is closely linked to the tachycardia. The schematic in the right hand panels illustrates the mechanism. The wavefront circulates down the right bundle, through the interventricular septum, and up the left bundle (top panel). Ablation of the right bundle branch interrupts the circuit (bottom panel).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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