Multiple morphologies of ventricular tachycardia assessed by implantable cardioverter-defibrillator electrograms in a patient with Chagas disease, successfully treated with catheter ablation: modern problems, old solutions

• DOI: 10.1093/europace/eus053
• Publication Date: 2012-05-12T01:03:50Z
• Authors: C. Hadid; S. Gallino; D. Di Toro; L. Celano; C. Lopez; E. Duce; C. Labadet
• Keywords: Ischemic Cardiomyopathy

A 60-year-old man with Chagas disease, implanted an implantable cardioverter defibrillator (ICD), experienced electrical storm. The ICD-stored electrograms revealed several ventricular tachycardia (VT) episodes two different morphologies, confirmed thereafter by surface electrocardiogram. Both VTs originated from re-entry circuits and were successfully ablated. This case highlights the usefulness of ICD in identifying as having sites origin. Analysis cardioverter-defibrillator (ICD-EG) showed that monomorphic QRS morphologies during (multiple MM) predicted higher mortality. 1 (Medtronic Maximo-VR7232) for secondary prevention death, disease left ejection fraction (LVEF), 0.45 was hospitalized interrogation 62 VT. Analysing ICD-EG, a difference morphology seen only HVA/HVB electrogram (a QS complex Figure 1A; Qr 1B). During hospitalization he VT surface-electrocardiogram Schematic representation endocardial ventricle. (A) (B) Implantable defibrillator- stored showing electrogram. Note this is not evident Vtip-Vring (C) (D) Twelve-lead electrocardiogram spontaneous tachycardia. (E) (F) Surface recordings tachycardias induced at electrophysio- logicalstudy.NotethatQRSconfigurationsofinducedventriculartachycardiasmatchthoseofthespontaneousventriculartachycardias. There mismatch lead V6 1, probably due to electrode position.