Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia

被引:1
作者
Xu, Xiaoyong [1 ]
Ye, Ming [2 ]
Sun, Yaxun [3 ]
Liu, Qiang [3 ]
Ma, Fusheng [1 ]
Jiang, Chenyang [3 ]
机构
[1] Li Huili Hosp, Ningbo Med Treatment Ctr, Dept Cardiol, Ningbo, Peoples R China
[2] Li Huili Hosp, Ningbo Med Treatment Ctr, Dept Electrophysiol, Ningbo, Peoples R China
[3] Zhejiang Univ, Sir Run Run Shaw Hosp, Sch Med, Dept Cardiol, Hangzhou, Peoples R China
关键词
ventricular tachycardia; homologous ventricular separation; catheter ablation; complication; substrate modification; RHYTHM; OUTCOMES;
D O I
10.3389/fcvm.2021.748194
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The substrate for ventricular tachycardia (VT) in patients with structural heart disease is usually complex and often requires extensive ablation. As a result, the incidence of major procedure-related complications has been reported to be higher when compared to patients without structural heart disease. In this study, we present a rare complication after extensive substrate modification of scar-related VT.Case: A 65-year-old man with ischemic cardiomyopathy was referred to the electrophysiology laboratory for radiofrequency ablation of VT following repetitive implantable cardioverter defibrillator shocks within a short period. As with hemodynamic intolerance of induced VT, an approach involving extensive endocardial substrate modification to reduce the arrhythmogenicity of the scars was adopted. After the procedure, the heart function of the patient deteriorated significantly. The postprocedural ECG showed a bizarre, extremely wide surface QRS complex (360 ms), termed as homologous ventricular separation. The pronounced dyssynchrony of the ventricle was corrected by an upgrade to cardiac resynchronization therapy with defibrillation (CRT-D). As a result, the symptoms of the patient improved significantly. The width of the intrinsic QRS complex was not recovered during an 18-month follow-up.Conclusion: Homologous ventricular separation is a rare arrhythmia, manifested as two separated QRS waves. This case report demonstrates, for the first time, that homologous ventricular separation may occur after extensive substrate modification of scar-related VT. CRT-D can correct the dyssynchronous ventricle caused by homologous ventricular separation.
引用
收藏
页数:6
相关论文
共 11 条
[1]   PSEUDO-ATRIAL RHYTHM DUE TO ELECTRICAL VENTRICULAR SEPARATION [J].
ALGEO, SS ;
EWY, GA .
AMERICAN HEART JOURNAL, 1985, 109 (04) :900-902
[2]   Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis [J].
Briceno, David F. ;
Romero, Jorge ;
Villablanca, Pedro A. ;
Londono, Alejandra ;
Diaz, Juan C. ;
Maraj, Ilir ;
Batul, Syeda Atiqa ;
Madan, Nidhi ;
Patel, Jignesh ;
Jagannath, Anand ;
Mohanty, Sanghamitra ;
Mohanty, Prasant ;
Gianni, Carola ;
Della Rocca, Domenico ;
Sabri, Ahlam ;
Kim, Soo G. ;
Natale, Andrea ;
Di Biase, Luigi .
EUROPACE, 2018, 20 (01) :104-115
[3]   2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA) [J].
Brignole, Michele ;
Auricchio, Angelo ;
Baron-Esquivias, Gonzalo ;
Bordachar, Pierre ;
Boriani, Giuseppe ;
Breithardt, Ole-A ;
Cleland, John ;
Deharo, Jean-Claude ;
Delgado, Victoria ;
Elliott, Perry M. ;
Gorenek, Bulent ;
Israel, Carsten W. ;
Leclercq, Christophe ;
Linde, Cecilia ;
Mont, Lluis ;
Padeletti, Luigi ;
Sutton, Richard ;
Vardas, Panos E. ;
Luis Zamorano, Jose ;
Achenbach, Stephan ;
Baumgartner, Helmut ;
Bax, Jeroen J. ;
Bueno, Hector ;
Dean, Veronica ;
Deaton, Christi ;
Erol, Cetin ;
Fagard, Robert ;
Ferrari, Roberto ;
Hasdai, David ;
Hoes, Arno W. ;
Kirchhof, Paulus ;
Knuuti, Juhani ;
Kolh, Philippe ;
Lancellotti, Patrizio ;
Linhart, Ales ;
Nihoyannopoulos, Petros ;
Piepoli, Massimo F. ;
Ponikowski, Piotr ;
Sirnes, Per Anton ;
Luis Tamargo, Juan ;
Tendera, Michal ;
Torbicki, Adam ;
Wijns, William ;
Windecker, Stephan ;
Kirchhof, Paulus ;
Blomstrom-Lundqvist, Carina ;
Badano, Luigi P. ;
Aliyev, Farid ;
Baensch, Dietmar ;
Baumgartner, Helmut .
EUROPEAN HEART JOURNAL, 2013, 34 (29) :2281-2329
[4]   INTRAVENTRICULAR DISSOCIATION DUE TO COMPLETE INTRAVENTRICULAR BLOCK [J].
CASTELLANOS, A ;
SUNG, RJ ;
MYERBURG, RJ .
CHEST, 1975, 68 (06) :833-834
[5]   Safety and Outcomes of Ventricular Tachycardia Substrate Ablation During Sinus Rhythm A Prospective Multicenter Registry [J].
Fernandez-Armenta, Juan ;
Soto-Iglesias, David ;
Silva, Etel ;
Penela, Diego ;
Jauregui, Beatriz ;
Linhart, Markus ;
Bisbal, Felipe ;
Acosta, Juan ;
Fernandez, Marcos ;
Borras, Roger ;
Villuendas, Roger ;
Cano, Lucas ;
Guasch, Eduard ;
Mont, Lluis ;
Berruezo, Antonio .
JACC-CLINICAL ELECTROPHYSIOLOGY, 2020, 6 (11) :1435-1448
[6]   PACEMAKER FAILURE DUE TO PROCAINAMIDE TOXICITY [J].
GAY, RJ ;
BROWN, DF .
AMERICAN JOURNAL OF CARDIOLOGY, 1974, 34 (06) :728-732
[7]  
Jain Shashank, 2019, HeartRhythm Case Rep, V5, P201, DOI 10.1016/j.hrcr.2018.12.010
[8]   Echocardiographic markers of dyssynchrony as predictors of super-response to cardiac resynchronisation therapy - a pilot study [J].
Kuznetsov, V. A. ;
Soldatova, A. M. ;
Kasprzak, J. D. ;
Krinochkin, D., V ;
Melnikov, N. N. .
CARDIOVASCULAR ULTRASOUND, 2018, 16
[9]  
Muser Daniele, 2017, JACC Clin Electrophysiol, V3, P767, DOI 10.1016/j.jacep.2017.01.020
[10]   Long-Term Outcome of Substrate Modification in Ablation of Post-Myocardial Infarction Ventricular Tachycardia [J].
Wolf, Michael ;
Sacher, Frederic ;
Cochet, Hubert ;
Kitamura, Takeshi ;
Takigawa, Masateru ;
Yamashita, Seigo ;
Vlachos, Konstantinos ;
Cheniti, Ghassen ;
Frontera, Antonio ;
Martin, Ruairidh ;
Thompson, Nathaniel ;
Massoullie, Gregoire ;
Lam, Anna ;
Martin, Claire ;
Collot, Florent ;
Duchateau, Josselin ;
Pambrun, Thomas ;
Denis, Arnaud ;
Derval, Nicolas ;
Hocini, Meleze ;
Haissaguerre, Michel .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2018, 11 (02)