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.