A Case of Cardiac Sarcoidosis in which Ventricular Tachycardia Termination without Global Capture was Recorded at the Thinning Basal Interventricular Septum

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  • 心室中隔基部の菲薄化領域に必須緩徐伝導路を有し，VT termination without global captureの所見を認めた心サルコイドーシスの1例

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A 60-year-old female who was diagnosed with cardiac sarcoidosis admitted to our hospital because of recurrent ventricular tachycardia (VT). Echocardiography showed thinning of the basal interventricular septum and ejection fraction of 26%. Left ventriculography revealed a ventricular aneurysm involving the anterior region, apex and septal segment despite normal coronary arteries. CARTO voltage mapping of both ventricles showed a low voltage area (LVA) only in the basal interventricular septum. Moreover, there were 4 scar points where maximum output pacing could not be captured in the LVA of the basal anteroseptal right ventricle. A VT (left bundle branch block pattern and superior axis) with a cycle length (CL) of 440 ms was induced by a single right ventricular extrastimulus. Delayed potentials were recorded from a His bundle electrode during sinus rhythm, and further more, mid-diastolic potential (MDP) was recorded during the VT. An isochronal map displayed a figure-8 reentry between the right septal scars. A phenomenon of VT termination without global capture was observed during entrainment pacing at the center of the LVA, where the MDP was recorded. At that site, VT was terminated by a single radiofrequency energy application. The VT became non-inducible after creating a linear ablation between the scars. This is the first case in which this rare phenomenon has been recorded in a patient with cardiac sarcoidosis.

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