case_images: PMC11747230_01
case_images: Ventricular tachycardia episode captured on the patient's cardiac monitor.
case_images: fsurg-11-1449007-g001.jpg
case_images: PMC11747230_01_fsurg-11-1449007-g001.jpg
case_images: F1
case_images: The induced VT (Figure 2A) was similar to the patient's symptomatic episodes (Figure 1).
case_images: (A) 12-lead ECG during ventricular tachycardia (VT) episode.Due to the requirement for an anterior thoracotomy, the precordial leads were placed on the iliac crest. As a result, the precordial lead reference differed from the VT morphology typically observed during the patient's daily episodes, but the limb lead morphology was consistent with the patient's daily VT episodes. (B) Epicardial substrate map during sinus rhythm (posterior-anterior view), with the scar area shown in gray, indicating no electrical activity. (C) Epicardial substrate map during sinus rhythm (left lateral view), with the scar area shown in gray, indicating no electrical activity. (D, E) Mapping during VT, with the earliest activation point indicated by the blue arrow. (F) Mapping target potential, showing fragmented waves in high-density mapping, significantly preceding the QRS complex in the surface ECG.
case_images: fsurg-11-1449007-g002.jpg
case_images: PMC11747230_01_fsurg-11-1449007-g002.jpg
case_images: F2
case_images: During sinus rhythm, a large low-voltage area was observed in the left ventricle (Figures 2B, C). The induced VT (Figure 2A) was similar to the patient's symptomatic episodes (Figure 1). The earliest activation points during VT coincided with the low-voltage scar areas observed during sinus rhythm, with significant fragmented potentials preceding the surface QRS complex (Figures 2D, E, F).
case_images: (A) Cryoablation of scar-related ventricular tachycardia. (B) Alternating ablation of the LVAD device incision site using dual cryoballoons. (C) Suturing after the completion of LVAD implantation and ablation.
case_images: fsurg-11-1449007-g003.jpg
case_images: PMC11747230_01_fsurg-11-1449007-g003.jpg
case_images: F3
case_images: Guided by three-dimensional mapping, the target areas were delineated, and scar-related VAs were ablated using cryoballoon technology (Figure 3A), including the left ventricular apex inflow cannula anastomosis site (Figure 3B). To further reduce operative time, dual cryoballoons were used alternately and continuously to ablate the incision area (Figure 3B).