Figure legends:
Figure 1: Surface electrocardiograms of different ventricular tachycardias (VT) induced during the electrophysiology study. The small variation in morphologies and cycle lengths, indicate variable exits of intramural substrates. Milliseconds: ms.
Figure 2: A and B are showing endocardial voltage mapping with peri-aortic and peri-mitral annulus low voltage areas indicating scar.
C and D showing RAO and LAO projections of the epicardial voltage mapping. Low voltage zones are noted at the antero-septal wall and the basal anterolateral wall.
Figure 3: Endocardial and epicardial coherent activation mapping during ventricular tachycardia. A and B figures show complex reentry circuit in the endocardial and epicardial levels respectively. Local activation time (LAT) histogram showed incomplete ventricular tachycardia cycle length (70%) despite best efforts of comprehensive mapping during ventricular arrhythmia.
C & D figures showing concurrent epi/endocardial electro-anatomical shell with projected radiofrequency ablation lesions from both sides in attempt to bracket the intra-mural myocardial substrates.
Supplemental Video:
Simultaneous epicardial and endocardial activation mapping (CARTO CONFIDENSETM Ripple Mapping) during ventricular tachycardia. Activation timing gap is noted during continues activation between the two opposite surfaces with the lack of intra-mural activation mapping.