Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia

Background: The substrate for ventricular tachycardia (VT) in patients with structural heart disease is usually complex and often requires extensive ablation. As a result, the incidence of major procedure-related complications has been reported to be higher when compared to patients without structur...

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Autores principales:	Xiaoyong Xu, Ming Ye, Yaxun Sun, Qiang Liu, Fusheng Ma, Chenyang Jiang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ventricular tachycardia homologous ventricular separation catheter ablation complication substrate modification Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/a1267f26a3144db2b75eac54f7e866af
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spelling	oai:doaj.org-article:a1267f26a3144db2b75eac54f7e866af2021-11-22T04:58:01ZCase Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia2297-055X10.3389/fcvm.2021.748194https://doaj.org/article/a1267f26a3144db2b75eac54f7e866af2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.748194/fullhttps://doaj.org/toc/2297-055XBackground: The substrate for ventricular tachycardia (VT) in patients with structural heart disease is usually complex and often requires extensive ablation. As a result, the incidence of major procedure-related complications has been reported to be higher when compared to patients without structural heart disease. In this study, we present a rare complication after extensive substrate modification of scar-related VT.Case: A 65-year-old man with ischemic cardiomyopathy was referred to the electrophysiology laboratory for radiofrequency ablation of VT following repetitive implantable cardioverter defibrillator shocks within a short period. As with hemodynamic intolerance of induced VT, an approach involving extensive endocardial substrate modification to reduce the arrhythmogenicity of the scars was adopted. After the procedure, the heart function of the patient deteriorated significantly. The postprocedural ECG showed a bizarre, extremely wide surface QRS complex (360 ms), termed as homologous ventricular separation. The pronounced dyssynchrony of the ventricle was corrected by an upgrade to cardiac resynchronization therapy with defibrillation (CRT-D). As a result, the symptoms of the patient improved significantly. The width of the intrinsic QRS complex was not recovered during an 18-month follow-up.Conclusion: Homologous ventricular separation is a rare arrhythmia, manifested as two separated QRS waves. This case report demonstrates, for the first time, that homologous ventricular separation may occur after extensive substrate modification of scar-related VT. CRT-D can correct the dyssynchronous ventricle caused by homologous ventricular separation.Xiaoyong XuMing YeYaxun SunQiang LiuFusheng MaChenyang JiangFrontiers Media S.A.articleventricular tachycardiahomologous ventricular separationcatheter ablationcomplicationsubstrate modificationDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ventricular tachycardia homologous ventricular separation catheter ablation complication substrate modification Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	ventricular tachycardia homologous ventricular separation catheter ablation complication substrate modification Diseases of the circulatory (Cardiovascular) system RC666-701 Xiaoyong Xu Ming Ye Yaxun Sun Qiang Liu Fusheng Ma Chenyang Jiang Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
description	Background: The substrate for ventricular tachycardia (VT) in patients with structural heart disease is usually complex and often requires extensive ablation. As a result, the incidence of major procedure-related complications has been reported to be higher when compared to patients without structural heart disease. In this study, we present a rare complication after extensive substrate modification of scar-related VT.Case: A 65-year-old man with ischemic cardiomyopathy was referred to the electrophysiology laboratory for radiofrequency ablation of VT following repetitive implantable cardioverter defibrillator shocks within a short period. As with hemodynamic intolerance of induced VT, an approach involving extensive endocardial substrate modification to reduce the arrhythmogenicity of the scars was adopted. After the procedure, the heart function of the patient deteriorated significantly. The postprocedural ECG showed a bizarre, extremely wide surface QRS complex (360 ms), termed as homologous ventricular separation. The pronounced dyssynchrony of the ventricle was corrected by an upgrade to cardiac resynchronization therapy with defibrillation (CRT-D). As a result, the symptoms of the patient improved significantly. The width of the intrinsic QRS complex was not recovered during an 18-month follow-up.Conclusion: Homologous ventricular separation is a rare arrhythmia, manifested as two separated QRS waves. This case report demonstrates, for the first time, that homologous ventricular separation may occur after extensive substrate modification of scar-related VT. CRT-D can correct the dyssynchronous ventricle caused by homologous ventricular separation.
format	article
author	Xiaoyong Xu Ming Ye Yaxun Sun Qiang Liu Fusheng Ma Chenyang Jiang
author_facet	Xiaoyong Xu Ming Ye Yaxun Sun Qiang Liu Fusheng Ma Chenyang Jiang
author_sort	Xiaoyong Xu
title	Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
title_short	Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
title_full	Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
title_fullStr	Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
title_full_unstemmed	Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia
title_sort	case report: a rare complication following catheter ablation of scar-related ventricular tachycardia
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a1267f26a3144db2b75eac54f7e866af
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Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia

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