Josephson Clinical Cardiac Electrophysiology


Solving problems, then and now. The left panel demonstrates the mechanism of subendocardial resection (adapted from Figure 11.262 ). ( A ) Bipolar recordings from a plaque elec trode positioned over the site of ventricular tachycardia origin have abnormal and fractionated electrograms. ( B ) After suben docardial resection, recordings from the same area show nor mal electrograms without fractionated or late potentials. The right panel is a three-dimensional reconstruction (courtesy

of Saman Nazarian, MD) of the left ventricle in a patient with ventricular tachycardia in the setting of nonischemic cardio myopathy and midseptal substrate (depicted by the gray shad ing in the midseptal and periaortic regions). Endocardial and epicardial (venous alcohol) ablation lesions are represented by the red areas. The substrate is much more extensive than the area of ablation, and ventricular tachycardia continued until it was successfully treated with cardiac radioablation.

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