Sustained Right Ventricular Tachycardia Originating Close to Defibrillator Lead Tip in Hypertrophic Cardiomyopathy

Abstract

The case of a 57-year-old woman with a longstanding history of obstructive hypertrophic cardiomyopathy in dilatative phase and incessant monomorphic ventricular tachycardia is reported. Endocardial recordings and electroanatomic mapping suggested local reentry involving right ventricular apical septum, close to a pacing/defibrillation lead tip. Radiofrequency pulses delivered at this site resulted in definite cure of the arrhythmia. It is possible that fibrotic reaction around pacing/defibrillation lead in a diseased myocardium substrate has contributed to the creation of a reentry circuit.

Ventricular tachycardia secondary to abandoned epicardial pacemaker lead

“…This rare scenario has been described for endocardial pacing and defibrillator lead tips2, 3, 4 as well as secondary to the lead shaft itself 5, 6, 7. It also has been documented with fractured and migrated epicardial leads in the setting of perforation 8, 9.…”

First direct human evidence of a probable implantable cardioverter-defibrillator lead-related scar serving as a substrate for ventricular tachycardia

“…Moreover, there is growing evidence of the proarrhythmic effects of pacemaker or ICD leads long after implantation. The pathophysiologic mechanism can be lead fracture, epicardial perforation, local scar formation around the tip, or a change in the activation pattern of the ventricles caused by epicardial or endocardial pacing 1, 2, 3, 4. Proof of lead-related arrhythmogenesis is based on indirect evidence such as identical pace-map from the lead tip, activation or voltage mapping, or noninducibility of the tachycardia after lead removal 2 .…”