Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

Ventricular tachycardia (VT) occurring late after myocardial infarction is often due to reentry circuit in the peri-infarct zone. The circuit is usually located in the sub-endocardium, though subepicardial substrates are known. Activation mapping during VT to identify target regions for ablation can be difficult if VT is non inducible or poorly tolerated. In the latter, a substrate based approach of mapping during sinus rhythm in conjunction with pace mapping helps to define the reentry circuit and select target sites for ablation in majority of patients with hemodynamically unstable VT. Percutaneous epicardial catheter ablation has been attempted as an approach where ablation by a conventional endocardial access has been unsuccessful. We report a case of post myocardial infarction scar VT which could be successfully ablated with a substrate based approach from the epicardial aspect

Primary primitive neuroectodermal tumor: An unusual cause of right ventricular intracavitary obstruction in a child

A six-year-old boy presented with a brief history suggestive of right heart failure. Investigations revealed a mass filling almost the entire right ventricle. Palliative resection of the mass was done. The operative specimen revealed a primary primitive neuroectodermal tumor of the heart, the first of its kind reported in the pediatric age group

Primary primitive neuroectodermal tumor: An unusual cause of right ventricular intracavitary obstruction in a child

A six-year-old boy presented with a brief history suggestive of right heart failure. Investigations revealed a mass filling almost the entire right ventricle. Palliative resection of the mass was done. The operative specimen revealed a primary primitive neuroectodermal tumor of the heart, the first of its kind reported in the pediatric age group

Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD) reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT) from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem

fQRS as a marker of granulomatous disease in patients presenting with ventricular tachycardia and normal left ventricular ejection fraction

Background: Granulomatous myocarditis may present with sustained monomorphic ventricular tachycardia (SMVT) in the presence of normal left ventricular ejection fraction (LVEF), and could be mistaken for idiopathic ventricular tachycardia (IVT). The use of cardiac imaging for diagnosis can be limited by availability and high cost. ECG is readily available and inexpensive. Fragmented QRS (fQRS) on ECG has been found to be associated with myocardial scar. We hypothesized that fQRS could be useful in the diagnosis of granulomatous VT (GVT). Methods: We compared the 12-lead ECG of 16 patients with GVT and 42 patients with IVT who presented with SMVT. Results: The presence of fQRS was significantly higher in the GVT group compared to the IVT group (75% versus 19.1%, p < 0.001). The location of fQRS correlated with delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in the same segment in 4/16 patients in the GVT group. It correlated with an affected segment on either DE-CMR or 18FDG positron emission computed tomography in 4/11 patients in the GVT group who had both imaging modality. Whenever fQRS was present in contiguous leads other than the inferior leads, it always corresponded to an affected segment on imaging. Conclusions: In patients presenting with SMVT and no structural heart disease, the presence of fQRS is strongly associated with granulomatous myocarditis. fQRS on the surface ECG is a helpful tool the presence of which should prompt a CMR for a definitive diagnosis