This Article Full Text Full Text (PDF) All Versions of this Article: 107/21/2702    most recent 01.CIR.0000068343.69532.B6v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ouyang, F. Articles by Kuck, K.-H. Search for Related Content PubMed PubMed Citation Articles by Ouyang, F. Articles by Kuck, K.-H. Related Collections Electrophysiology Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2003;107:2702.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms

Feifan Ouyang, MD; Matthias Antz, MD; Florian T. Deger, MD; Dietmar Bänsch, MD; Anselm Schaumann, MD; Sabine Ernst, MD; Karl-Heinz Kuck, MD

From the II. Med. Abteilung, Allgemeines Krankenhaus St Georg, Hamburg, Germany.

Correspondence to Feifan Ouyang, MD, II. Med. Abteilung, Allgemeines Krankenhaus St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany. E-mail Ouyangfeifan{at}aol.com

Background— In patients with apparently normal hearts, ventricular tachycardia (VT) may only involve the subepicardial myocardium.

Methods and Results— Four patients with exercise-induced fast VT with right bundle branch block morphology were investigated. ECG showed a small q wave in leads II, III, and aVF during sinus rhythm (SR) in all 4 patients. Left ventricular angiography showed small inferolateral aneurysms in all patients. Coronary arteriograms were normal in all 4 patients. Six unstable VTs (cycle length, 200 to 305 ms) and 1 stable VT (cycle length 370 ms) were reproducibly induced in the 4 patients. During SR, endocardial mapping was normal in all 4 patients, and epicardial mapping showed fragmented and late potentials in the left inferolateral wall anatomically consistent with the left ventricle aneurysm. During tachycardia, epicardial mapping showed a macroreentrant VT with focal endocardial activation in the patient with stable VT, whereas in 2 patients with unstable VT, a diastolic potential was only recorded and coincided with the late potential in the same area. Epicardial ablation was performed in 3 patients and successfully abolished those VTs. No VT recurred in 2 patients during follow-up of 2 and 9 months. Clinical VT recurred 6 months after the ablation and was successfully ablated in a repeated epicardial ablation in 1 patient. In the remaining patient without epicardial ablation, an implantable cardiac defibrillator was implanted. There were multiple shocks during a follow-up of 31 months.

Conclusions— In patients with normal coronary arteriograms and left ventricle aneurysm, exercise-induced VT with right bundle branch block morphology may have a subepicardial arrhythmogenic substrate, which may be amenable to epicardial ablation.

Key Words: cardiomyopathy • mapping • syncope • tachycardia

This article has been cited by other articles:

				M. S. Maron, J. J. Finley, J. M. Bos, T. H. Hauser, W. J. Manning, T. S. Haas, J. R. Lesser, J. E. Udelson, M. J. Ackerman, and B. J. Maron Prevalence, Clinical Significance, and Natural History of Left Ventricular Apical Aneurysms in Hypertrophic Cardiomyopathy Circulation, October 7, 2008; 118(15): 1541 - 1549. [Abstract] [Full Text] [PDF]

				M. Paul, M. Schafers, M. Grude, F. Reinke, K. U. Juergens, R. Fischbach, O. Schober, G. Breithardt, and T. Wichter Idiopathic left ventricular aneurysm and sudden cardiac death in young adults. Europace, August 1, 2006; 8(8): 607 - 612. [Abstract] [Full Text] [PDF]

				A. Berruezo, L. Cano, L. Mont, and J. Brugada Epicardial ablation of syncopal ventricular tachycardia. Utility of the electrocardiogram. Europace, January 1, 2006; 8(5): 338 - 340. [Abstract] [Full Text] [PDF]

				A. Frustaci, S. G. Priori, M. Pieroni, C. Chimenti, C. Napolitano, I. Rivolta, T. Sanna, F. Bellocci, and M. A. Russo Cardiac Histological Substrate in Patients With Clinical Phenotype of Brugada Syndrome Circulation, December 13, 2005; 112(24): 3680 - 3687. [Abstract] [Full Text] [PDF]

				D. P. Zipes The year in electrophysiology J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1306 - 1314. [Full Text] [PDF]

				J. W. Auer, R. Berent, B. Eber, F. Ouyang, M. Antz, F. T. Deger, D. Bansch, A. Schaumann, S. Ernst, and K.-H. Kuck Small Left Ventricular Aneurysms in Patients With Ventricular Tachyarrhythmias and Normal Coronary Arteriograms * Response Circulation, December 23, 2003; 108 (25): e174 - e174. [Full Text] [PDF]