Histopathological verification for successful ablation of mitral isthmus ventricular tachycardia complicated with cardiac sarcoidosis

Intern Med. 2012;51(3):281-5. doi: 10.2169/internalmedicine.51.6307. Epub 2012 Feb 1.

Abstract

A 68-year-old man died a few days after catheter ablation of drug-resistant, monomorphic ventricular tachycardia (VT) complicated with cardiac sarcoidosis. The diagnosis of mitral isthmus VT was made from electrophysiological observations, including electro-anatomical activation and voltage map, pace-mapping, entrainment mapping and ablation outcome. On autopsy of the heart, sarcoidic lesion with scattered fibrous tissue in the mitral isthmus was non-transmural, and the surviving myocardium serving as the reentry circuit in the endomyocardium was isolated from the adjacent viable epimyocardium, enabling the sustenance of macroreentry across the mitral isthmus. Non-transmural lesions produced by RF delivery created a barrier sufficient to interrupt the myocardial bundles located in the mitral isthmus, eliminating the mitral isthmus VT.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cardiomyopathies / complications
  • Cardiomyopathies / pathology*
  • Catheter Ablation* / methods
  • Fatal Outcome
  • Humans
  • Male
  • Mitral Valve / pathology*
  • Sarcoidosis / complications
  • Sarcoidosis / pathology*
  • Tachycardia, Ventricular / complications
  • Tachycardia, Ventricular / pathology*