Ventricular tachycardia due to isolated non-compaction of the right ventricle

Ventricular tachycardia due to isolated non-compaction of the right ventricle Image Focus 1 IMAGE FOCUS doi:10.1093/ehjci/jey068 .................................................................................................................................................... Ventricular tachycardia due to isolated non-compaction of the right ventricle 1 2 2 2 1 T. Rambhatla , S. Mountantonakis , K. Bhasin , N. Skipitaris , and I. Kronzon * Department of Cardiovascular Disease, Lenox Hill Hospital—Northwell Health, 100 East 77th St., 2nd Floor Non-Invasive Cardiology, New York, NY, USA; and Heart Rhythm Center, Lenox Hill Hospital—Northwell Health, 100 East 77th St., 2nd Floor Non-Invasive Cardiology, New York, NY, USA * Corresponding author. Tel: 212-434-6119; Fax: 212-434-2347. E-mail: kronzon@aol.com A 55-year-old healthy man presented in ventricular tachycardia (VT) with a left bundle branch block morphology and superior axis (Panel A). Cardioversion was performed and revealed sinus rhythm (Panel A), right bundle branch block, and a wide fractionated S wave (Panel B, arrow). Transthoracic echocardiogram and coro- nary angiography were unremarkable. Evidence of delayed conduction in the right ventricle (RV) on electrocardiogram and localization of the VT to the inferior RV prompted cardiac magnetic resonance imaging (Panels C and D). A non-com- pacted hypertrabeculated spongy layer of the right ventricular apex and free wall was identified (arrows), with a ratio greater than 2.3:1 of the compacted layer, segmen- tal hypokinesis with an ejection fraction of 35% (see Supplementary data online, Video S1), and no evidence of fatty infiltration on black- blood T1 weighted imaging. In the electrophysiology laboratory, rapid ventricular pacing induced the clinical VT. Electroanatomic mapping and pace mapping located the VT origin to the right ventricular basal free and inferior wall. Radiofrequency (RF) ablation at this site induced VT; after several RF appli- cations, VT was no longer inducible. An implantable cardioverter-defibrillator was placed, and at 16-month follow-up, no further episodes of VT occurred. Isolated ventricular non-compaction is a primary cardiomyopathy that affects the left ventricle and is known to cause ven- tricular arrhythmias. Cases of non-compaction isolated to the RV without left ventricular involvement have been reported; however, they are often incidentally found, and have not been described to cause VT. We describe a case of isolated non-compaction of the RV causing VT and successful elimination with catheter ablation. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jey068/4994999 by Ed 'DeepDyve' Gillespie user on 11 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Ventricular tachycardia due to isolated non-compaction of the right ventricle

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey068
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Abstract

Image Focus 1 IMAGE FOCUS doi:10.1093/ehjci/jey068 .................................................................................................................................................... Ventricular tachycardia due to isolated non-compaction of the right ventricle 1 2 2 2 1 T. Rambhatla , S. Mountantonakis , K. Bhasin , N. Skipitaris , and I. Kronzon * Department of Cardiovascular Disease, Lenox Hill Hospital—Northwell Health, 100 East 77th St., 2nd Floor Non-Invasive Cardiology, New York, NY, USA; and Heart Rhythm Center, Lenox Hill Hospital—Northwell Health, 100 East 77th St., 2nd Floor Non-Invasive Cardiology, New York, NY, USA * Corresponding author. Tel: 212-434-6119; Fax: 212-434-2347. E-mail: kronzon@aol.com A 55-year-old healthy man presented in ventricular tachycardia (VT) with a left bundle branch block morphology and superior axis (Panel A). Cardioversion was performed and revealed sinus rhythm (Panel A), right bundle branch block, and a wide fractionated S wave (Panel B, arrow). Transthoracic echocardiogram and coro- nary angiography were unremarkable. Evidence of delayed conduction in the right ventricle (RV) on electrocardiogram and localization of the VT to the inferior RV prompted cardiac magnetic resonance imaging (Panels C and D). A non-com- pacted hypertrabeculated spongy layer of the right ventricular apex and free wall was identified (arrows), with a ratio greater than 2.3:1 of the compacted layer, segmen- tal hypokinesis with an ejection fraction of 35% (see Supplementary data online, Video S1), and no evidence of fatty infiltration on black- blood T1 weighted imaging. In the electrophysiology laboratory, rapid ventricular pacing induced the clinical VT. Electroanatomic mapping and pace mapping located the VT origin to the right ventricular basal free and inferior wall. Radiofrequency (RF) ablation at this site induced VT; after several RF appli- cations, VT was no longer inducible. An implantable cardioverter-defibrillator was placed, and at 16-month follow-up, no further episodes of VT occurred. Isolated ventricular non-compaction is a primary cardiomyopathy that affects the left ventricle and is known to cause ven- tricular arrhythmias. Cases of non-compaction isolated to the RV without left ventricular involvement have been reported; however, they are often incidentally found, and have not been described to cause VT. We describe a case of isolated non-compaction of the RV causing VT and successful elimination with catheter ablation. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jey068/4994999 by Ed 'DeepDyve' Gillespie user on 11 July 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: May 10, 2018

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