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- W4377015913 abstract "The mechanisms of monomorphic ventricular tachycardia (VT) include reentry, triggered acitivity and enhanced automaticity. Idiopathic VT originating from the papillary muscles are commonly due to enhanced automaticity. Premature ventricular contraction (PVC) originating from different sites inducing idiopathic VT have rarely been reported. To demonstrate a unique mechanism of idiopathic ventricular tachycardia. N/A 72-year-old man who presented with symptomatic frequent PVCs. Cardiac MRI showed LVEF of 28%, biventricular dilation and no late gadolinium enhancement. Coronary angiogram showed no significant coronary artery disease. 24-hour Holter showed 21% burden of single morphology PVCs and sustained VT with different morphology triggered by these PVCs. Amiodarone therapy was initiated. He was brought to the EP lab. Electroanatomic voltage mapping demonstrated normal left ventricular endocardial bipolar voltage. VT or ventricular fibrillation were not inducible delivering up to triple extrastimuli until VERP. The patient had numerous episodes of spontaneous VT that were triggered by one dominant PVC with different morphology. Identical pace maps were found for the PVC triggering VT at the location of the moderator band. A fascicular potential was also noted in this location. Extensive radiofrequency ablation was performed in this region using a Thermocool SmartTouch SF DF catheter. The frequency of spontaneous moderator band PVCs went from frequent to very rare. The PVCs were no longer inducing VTdespite isoproterenol infusion up to 5 mcg/min. The VT was localized to the anterolateral papillary muscle where excellent pace maps were found. Extensive ablation was performed in this region and the VT was no longer present despite aggressive burst pacing on and off isoproterenol up to 5 mcg/min. Since VT was thought to be idiopathic in nature and it was successfully ablated, decision was made not to place AICD. Amiodarone therapy was discontinued and an internal loop recorder was implanted for monitoring of recurrence. A repeated TTE has demonstrated improved LV systolic function. Ventricular tachycardia originating from the papillary muscles is widely known however PVCs from different sites triggering these arrthymias has not been reported to our knowldge. EP study and ablation should be considered as treatment for these." @default.
- W4377015913 created "2023-05-19" @default.
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- W4377015913 date "2023-05-01" @default.
- W4377015913 modified "2023-10-04" @default.
- W4377015913 title "PO-04-019 AN INTRIGUING CASE OF PVC-INDUCED VENTRICULAR TACHYCARDIA WITH ORIGIN AT DIFFERENT SITE. WHAT SHOULD BE ABLATED?" @default.
- W4377015913 doi "https://doi.org/10.1016/j.hrthm.2023.03.1148" @default.
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