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(Circulation. 2001;103:913.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ventricular Tachycardia Around the Tricuspid Annulus in Right Ventricular Dysplasia

Feifan Ouyang, MD; Parwis Fotuhi, MD; Masahiko Goya, MD; Marius Volkmer, MD; Sabine Ernst, MD; Riccardo Cappato, MD; Karl-Heinz Kuck, MD

From the Allgemeines Krankenhaus St Georg, Hamburg, Germany.

Correspondence to Karl-Heinz Kuck, MD, Allgemeines Krankenhaus St Georg, Lohmühlenstraße 5, 20099 Hamburg, Germany.

A 78-year-old man with palpitations, dizziness, and presyncope was referred to our institution for evaluation. He had first had symptoms at 46 years of age and received a single-chamber atrial pacemaker for suspected sick sinus syndrome.

A current angiogram showed an unremarkable left ventricle but a dilated right ventricular outflow tract and moderate dilatation of the right ventricular chamber. A diagnosis of right ventricular dysplasia was made, and the patient underwent an electrophysiological study to evaluate his palpitations and presyncope. During right ventricular stimulation, a sustained, hemodynamically stable, wide QRS complex tachycardia with a rate of 155 bpm could be reproducibly initiated (Figure 1).

View larger version (67K): [in this window] [in a new window]   Figure 1. Surface 12-lead ECG tracings during ventricular tachycardia. Note left bundle-branch configuration of QRS, with left axis deviation, suggesting a right inferolateral exit of reentrant circuit.

During tachycardia, endocardial mapping of the right and left ventricles was performed with a 3D electroanatomic mapping system (CARTO, Biosense Webster, Johnson & Johnson) to identify the reentry circuit before ablation.

A macroreentrant circuit located in the right ventricle was identified as the mechanism of the tachycardia. An area of slow conduction (speed of the electrical impulse, 0.55 m/s; Figure 2, zigzag arrow) was found between the tricuspid annulus and an area of scar tissue within the posterolateral outflow tract of the right ventricle. Voltage mapping showed an area of low-amplitude potential within the area of slow conduction (Figure 3, left). A linear radiofrequency lesion severing the anatomic isthmus between the tricuspid annulus and the scar area was . . . [Full Text of this Article]

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