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Archives of cardiovascular diseases
Volume 110, n° 5
pages 292-302 (mai 2017)
Doi : 10.1016/j.acvd.2017.01.009
Received : 9 November 2016 ;  accepted : 6 January 2017
Ten-year outcomes of monomorphic ventricular tachycardia catheter ablation in repaired tetralogy of Fallot
Résultats à 10 ans de l’ablation par cathéter des tachycardies ventriculaires monomorphes dans la tétralogie de Fallot réparée

Figure 1

Figure 1 : 

Two examples of clinical monomorphic ventricular tachycardias (VTs) in repaired tetralogy of Fallot. A: inferior-axis left bundle branch block-morphology VT (255bpm) in a 27-year-old patient referred for syncopal episodes; this morphology was the most common VT morphology in our population. B: left-axis left bundle branch block-morphology VT (260bpm) in a 47-year-old patient, responsible for haemodynamic instability.

Figure 2

Figure 2 : 

Bipolar voltage map in sinus rhythm showing right ventricle (RV) scar areas and anatomical isthmuses in a repaired tetralogy of Fallot patient undergoing ventricular tachycardia catheter ablation. A: right anterior oblique view of the three-dimensional bipolar voltage map of the right cavities merged to conventional fluoroscopy (CARTO® 3 UniVu™ electroanatomical mapping system; Biosense Webster Inc., Diamond Bar, CA, USA). Regions in red have low-amplitude local electrograms (0.01–0.30mV) corresponding to scar areas unresponsive to pacing. Regions in purple correspond to normal myocardium. Regions in grey in the right atrium correspond to dense surgical scar consecutive to atriotomy or cannulation. Black dots indicate fragmented and late potentials in sinus rhythm. A large scar area in continuity with the pulmonary annulus (PA) is seen in the anterosuperior portion of the RV, corresponding to a transannular right ventricular outflow tract (RVOT) patch. Isthmus 1 is located between the RVOT patch and the lateral tricuspid annulus (TA). B: septal view. The scar area corresponding to the ventricular septal defect patch is identified in its usual superior position, anterior to and above the His bundle (yellow ball). Isthmus 3 is located between the pulmonary annulus and the ventricular septal defect patch, and isthmus 4 is between the ventricular septal defect patch and the TA. C: posterior view. A large scar area in the posterior right atrium is identified and corresponds to the atriotomy. Fragmented potentials are seen in the isthmus 3 region. D: posteroseptal view. Radiofrequency applications are delivered in the isthmus 3 region (light pink to red balls). CS: coronary sinus; IVC: inferior vena cava; SVC: superior vena cava.

Figure 3

Figure 3 : 

Catheter ablation of macroreentrant ventricular tachycardia (VT) in a repaired tetralogy of Fallot recipient. A: unusual right bundle branch block-morphology VT with positive concordance in the precordial leads. B: three-dimensional VT activation map using the CARTO® system. Colour scale indicates local activation times from the earliest (red) to the latest (purple). All colours are seen within the right ventricle (RV), indicating macroreentry. The slow-conduction zone (sinusoidal black line) is located at the anterolateral wall of the RV, between the transannular right ventricular outflow tract patch and the tricuspid annulus, defining isthmus. 1 – radiofrequency applications are delivered on the slow-conduction zone (red dots). The right bundle branch block morphology with positive concordance is explained by the initial superior and basal septal activation related to a posterior VT exit beneath the pulmonary annulus C: VT termination (red arrow) after 3.7s of successful radiofrequency application in the slow-conduction zone.

Figure 4

Figure 4 : 

Long-term results. A, C and D: Kaplan–Meier estimates of freedom from death, ventricular tachycardia (VT) recurrence and implantable cardioverter-defibrillator (ICD) appropriate shock. B: Kaplan–Meier estimate of survival. LVEF: left ventricular ejection fraction.

Figure 5

Figure 5 : 

Two cases of sudden cardiac death. A: patient 1: necropsic study showing left ventricular fibrofatty remodelling consecutive to myocardial infarction (2.5× magnification; haematoxylin–eosin staining). B: patient 2: QRS complex evolution in a subject who presented ventricular fibrillation-related sudden cardiac death in 2005; there is a marked QRS complex enlargement over time and the apparition of a pseudoepsilon wave in V1, corresponding to right ventricular parietal block.

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