Single-application Radiofrequency Interruption in a Broad Isthmus Ventricular Tachycardia by Targeting the Longest Electrogram Visualized Using a New Customized Software (VEDUMap)

DOI: 10.19102/icrm.2021.120117S

FILIPPO M. CAUTI, MD,¹ STEFANO BIANCHI, MD,¹ and PIETRO ROSSI, MD, PhD¹

¹Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy

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KEYWORDS. Slow conduction, VEDUMap, ventricular tachycardia ablation.

The authors report no conflicts of interest for the published content.
Address correspondence to: Filippo Maria Cauti, MD. Email: filippocauti@hotmail.it.

A 63-year-old woman with a diagnosis of arrhythmogenic right ventricular cardiomyopathy was referred to our department for recurrent monomorphic ventricular tachycardia (VT) with left bundle branch block and intermediate axis. A previous endocardial procedure was ineffective. After pericardial access, a detailed electroanatomical sinus rhythm map was obtained to verify areas of slow conduction and local abnormal ventricular activation (Figure 1B). A confined spot of late potentials (LPs) was detected in an inferolateral aneurism. A marked deceleration zone in sinus rhythm was revealed at the base of the apex of the spot of LPs. VT was induced with a single extrastimulus and the full cycle length was recorded in the epicardium by the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ using the HD Wave acquisition algorithm (Figure 1A). The VT isthmus revealed a broad path with inferior entrance and anterolateral exit in the epicardial base of the right ventricle. Thus, a novel ventricular map (VEDUMap) of electrogram (EGM) duration (unpublished data), which considered the duration of the EGM in a color-coded fashion (white = longest to purple = shortest) displayed with auto-color was created (Figure 1C). The region of the prolonged EGM during VT corresponds to the slowest conduction in sinus rhythm. Radiofrequency (50 W at 43°C with an open irrigated catheter) (FlexAbility™ ablation catheter) was started at the white spot highlighted by the VEDUMap with sudden interruption of the tachycardia (green dot in Figure 1) (Video 1).

After a single RF pulse, the VT was no longer inducible up to the fourth extrastimulus. A line of radiofrequency energy was delivered between the two VT isthmus boundaries. LPs were abolished and confirmed by remapping. The patient remained free from arrhythmia at 11 months of follow-up.