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ELECTROANATOMIC CHARACTERIZATION OF HYPOPLASTIC LEFT HEART VENTRICULAR TACHYCARDIA: TRANSAORTIC TRANSMEMBRANOUS VENTRICULAR SEPTAL APPROACH VIA MAGNETIC NAVIGATION
2292 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making ELECTROANATOMIC CHARACTERIZATION OF HYPOPLASTIC LEFT HEART VENTRICULAR TACHYCARDIA: TRANSAORTIC TRANSMEMBRANOUS VENTRICULAR SEPTAL APPROACH VIA MAGNETIC NAVIGATION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-380 Authors: Andrew D. Beaser, Kelvin C. M. Chua, Michael Broman, Roderick Tung, University of Chicago Medical Center, Chicago, IL, USA
Background: Hypoplastic Left Heart (HLH) Syndrome is associated with atrial arrhythmias but the literature is sparse on the substrate for ventricular arrhythmias in these patients.
Case: A 35 year old man with congenital mitral atresia and associated HLH Syndrome presented for ablation for symptomatic premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT). This procedure required manipulation through a difficult to access ventricular septal defect (VSD) connecting the systemic ventricle to the HLH. Limited voltage mapping revealed dense scar in the HLH, treated with substrate modification. He returned two months later with NSVT and mexiletine intolerance.
Decision‐Making: The decision was to repeat ablation using remote magnetic navigation (Stereotaxis, St Louis, MO). The ablator was magnetically directed into the HLH via the VSD under transthoracic echocardiogram guidance. Extensive scar was identified throughout the HLH, which extended apically. Scar homogenization was performed.
Conclusions: This case highlights the importance of an ablation strategy utilizing technology tailored to the patient’s unique anatomy. Additionally, use of proper tools, in this case magnetic navigation, proved crucial in gaining access to the critical region in the HLH. Lastly, while atrial tachyarrhythmias and bradycardia are more prevalent in this population, the diffuse region of low voltage on the lateral wall of the HLH comprised arrhythmogenic substrate.
FIT Clinical Decision Making ELECTROANATOMIC CHARACTERIZATION OF HYPOPLASTIC LEFT HEART VENTRICULAR TACHYCARDIA: TRANSAORTIC TRANSMEMBRANOUS VENTRICULAR SEPTAL APPROACH VIA MAGNETIC NAVIGATION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-380 Authors: Andrew D. Beaser, Kelvin C. M. Chua, Michael Broman, Roderick Tung, University of Chicago Medical Center, Chicago, IL, USA
Background: Hypoplastic Left Heart (HLH) Syndrome is associated with atrial arrhythmias but the literature is sparse on the substrate for ventricular arrhythmias in these patients.
Case: A 35 year old man with congenital mitral atresia and associated HLH Syndrome presented for ablation for symptomatic premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT). This procedure required manipulation through a difficult to access ventricular septal defect (VSD) connecting the systemic ventricle to the HLH. Limited voltage mapping revealed dense scar in the HLH, treated with substrate modification. He returned two months later with NSVT and mexiletine intolerance.
Decision‐Making: The decision was to repeat ablation using remote magnetic navigation (Stereotaxis, St Louis, MO). The ablator was magnetically directed into the HLH via the VSD under transthoracic echocardiogram guidance. Extensive scar was identified throughout the HLH, which extended apically. Scar homogenization was performed.
Conclusions: This case highlights the importance of an ablation strategy utilizing technology tailored to the patient’s unique anatomy. Additionally, use of proper tools, in this case magnetic navigation, proved crucial in gaining access to the critical region in the HLH. Lastly, while atrial tachyarrhythmias and bradycardia are more prevalent in this population, the diffuse region of low voltage on the lateral wall of the HLH comprised arrhythmogenic substrate.