J Korean Med Sci.  2012 Feb;27(2):215-217. 10.3346/jkms.2012.27.2.215.

Radiofrequency Catheter Ablation of Hemodynamically Unstable Ventricular Tachycardia Associated with Systemic Sclerosis

• Chung HH
• Kim JB
• Hong SH
• Lee HJ
• Joung B
• Lee MH

• KMID: 1120162
• DOI: http://doi.org/10.3346/jkms.2012.27.2.215

Abstract

Systemic sclerosis (SS) is a connective tissue disease and cardiac involvement is common. Primary cardiac involvement such as conduction system disturbances and arrhythmias can also occur. However, reports of sustained ventricular tachycardia (VT) are rare. We report a case of catheter ablation of sustained ventricular tachycardia in a patient with systemic sclerosis using a conventional mapping system. A 64-yr-old woman with a 10-yr history of SS was referred for management of her ventricular tachycardia. There was no structural abnormality in cardiac chambers. However, electrophysiologic study revealed electrical substrate of ventricular tachycardia which could be ablated with pacemapping and substrate mapping. This case demonstrated successful conventional mapping and catheter ablation in a hemodynamically unstable patient with SS.

Keyword

Scleroderma Systemic; Tachycardia Ventricular; Catheter Ablation

MeSH Terms

*Catheter Ablation
Electrocardiography
Female
Humans
Middle Aged
Scleroderma, Systemic/*complications/*diagnosis
Tachycardia, Ventricular/*etiology/physiopathology/*surgery

Figure

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  Fig. 1 Initial ECG at emergency room. (A) Twelve lead ECG on admission revealed sustained monomorphic VT with LBBB configulation and left axis deviation. (B) Sinus rhythm with incomplete RBBB and normal QT interval (QTc:453 ms) was restored by electrical cardioversion.

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  Fig. 2 Induced VT during the electrophysiologic study. This VT was morphologically identical with clinically documented VT (LBBB morphology and left axis deviation).

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  Fig. 3 During substrate mapping in sinus rhythm, delayed and late potentials (black arrow) were identified at the mapping catheter.

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  Fig. 4 Pacemapping at the area of late potential showed good matching with induced VT. (A) 12 lead ECG during pacemapping (B) 12 lead ECG duing ventricular tachycardia.

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