Open AccessElectrical storm in systemic sclerosis: Inside the electroanatomic substrate
Author(s) -
Michela Casella,
Corrado Carbucicchio,
Eleonora Russo,
Francesca Pizzamiglio,
Paolo Golia,
Sergio Conti,
Fabrizio Costa,
Antonio Dello Russo,
Claudio Tondo
Publication year - 2014
Publication title -
world journal of cardiology
Language(s) - English
Resource type - Journals
ISSN - 1949-8462
DOI - 10.4330/wjc.v6.i10.1127
Subject(s) - medicine , cardiology , ablation , intracardiac injection , catheter ablation , pulmonary hypertension , catheter , atrial flutter , atrial fibrillation , radiology
We report the case of a 63-year-old woman affected by a severe form of systemic scleroderma with pulmonary involvement (interstitial fibrosis diagnosed by biopsy and moderate pulmonary hypertension) and cardiac involvement (paroxysmal atrial fibrillation, right atrial flutter treated by catheter ablation, ventricular tachyarrhythmias, previous dual chamber implantable cardioverter defibrillator implant). Because of recurrent electrical storms refractory to iv antiarrhythmic drugs the patient was referred to our institution to undergo catheter ablation. During electrophysiological procedure a 3D shell of cardiac anatomy was created with intracardiac echocardiography pointing out a significant right ventricular dilatation with a complex aneurysmal lesion characterized by thin walls and irregular multiple trabeculae. A substrate-guided strategy of catheter ablation was accomplished leading to a complete electrical isolation of the aneurism and to the abolishment of all abnormal electrical activities. The use of advanced strategies of imaging together with electroanatomical mapping added important information to the complex arrhythmogenic substrate and improved efficacy and safety.