Color Atlas and Synopsis of Electrophysiology 1st Edition [PDF]
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Color Atlas and Synopsis of Electrophysiology – 1st Edition
An 83-year-old woman with a history of coronary artery disease, ischemic cardiomyopathy, atrial fibrillation, diabetes mellitus, and hypertension presented to clinic for evaluation of recurrent ventricular tachycardia (VT).
The patient has a biventricular pacing defibrillator (ICD), initially placed for primary prevention 6 years earlier, and there were no detected ventricular arrhythmias until approximately 6
months prior to presenting when she had a first episode of sustained VT, postoperatively after hip surgery.
She has since had multiple episodes of VT requiring ICD therapies (both antitachycardia pacing as well
as shock) despite treatment with dual antiarrhythmic medications (sotalol and mexiletine).
Her past surgical history includes two coronary artery bypass surgeries as well as a bioprosthetic mitral valve
Her echocardiogram revealed an ejection fraction of 20% with basal inferior aneurysm and akinetic inferior and inferolateral walls.
The patient was admitted to the hospital for antiarrhythmic drug washout in preparation for VT ablation. On the evening prior to the scheduled procedure, she had a spontaneous episode of her clinical VT, which was of right bundle morphology with a superior axis and positive concordance across the
precordium at a cycle length of 370 ms, which was successfully terminated with internal defibrillation from her ICD.
The following day the patient was brought to the electrophysiology lab. Programmed stimulation was
performed to assess electrophysiologic properties of the ventricles and for arrhythmia induction.
Using the CARTO 3-dimensional electroanatomical mapping system (Biosense Webster, Diamond Bar,
CA), mapping was performed in the left ventricle both in sinus rhythm and after induction of tachycardia.