Korean Circ J.  2013 Feb;43(2):119-122. 10.4070/kcj.2013.43.2.119.

Unusual Polymorphic Ventricular Tachycardia Originating from the Pulmonary Artery

• Lee DI
• Park SW
• Kook H
• Kim W
• Kim DH
• Lee S
• Oh SK
• Kim YH

• KMID: 1769648
• DOI: http://doi.org/10.4070/kcj.2013.43.2.119

Abstract

We report a case about a 27-year-old healthy young male who developed syncope during exercise, which was subsequently identified to be attributable to non-sustained polymorphic ventricular tachycardia (VT). Occurrence of polymorphic VT was neither related to a prolonged QT interval nor a fixed short coupling interval. Standard examinations including echocardiography, coronary angiography, isoproterenol infusion study, and cardiac MRI showed no structural heart disease. On the electrophysiology study, activation mapping revealed that a discrete potential preceded the premature ventricular complex (PVC) triggered polymorphic VT, which was recorded just above the pulmonary valve. After radiofrequency ablation at this area, PVC and polymorphic VT disappeared and did not recur after a 2 month follow up.

Keyword

Ventricular tachycardia; Pulmonary artery; Radiofrequency catheter ablation

MeSH Terms

Catheter Ablation
Coronary Angiography
Echocardiography
Electrophysiology
Follow-Up Studies
Heart Diseases
Humans
Isoproterenol
Male
Pulmonary Artery
Pulmonary Valve
Syncope
Tachycardia, Ventricular
Ventricular Premature Complexes
Isoproterenol

Figure

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  Fig. 1 Frequent premature ventricular complex and non-sustained polymorphic ventricular tachycardia on baseline electrocardiography.

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  Fig. 2 The sample of the Holter electrocardiography showed frequent non-sustained polymorphic VT. The morphology of triggering PVC is uniform and identical to that of isolated PVC. Development of polymorphic VT is not related to fixed coupling interval of PVC. VT: ventricular tachycardia, PVC: premature ventricular complex.

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  Fig. 3 The position of the ablation catheter and Lasso catheter. The upper panel showed the adjustable Lasso catheter position within the pulmonary artery confirmed by angiography. White arrows indicated the level of the pulmonary valves. The purple line delineated the pulmonary artery and pulmonary valve. The lower panel showed the ablation catheter position during radiofrequency delivery, which was the anterior free wall side just above the pulmonary valve.

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  Fig. 4 Activation mapping revealed that local potential (arrows) above the pulmonary valve preceded the QRS by 60 msec. There was no visible signal at any other electrode of the Lasso catheter, which means the lack of excitable tissue within the other side of the pulmonary artery.

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  Fig. 5 One day after ablation, the electrocardiography showed normal sinus rhythm without premature ventricular complex.

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