Page 171 - YORAM RUDY BOOK FINAL

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Figure 5.30 shows ECGI activation maps during initiation, continuation and termination of

spontaneous VT in a 40-years-old patient, who experienced 248 VT episodes over 14 days .
331
Antitachycardia pacing (ATP) from an implanted device terminated the VT each time. ECGI
captured the entire sequence of VT initiation, continuation and termination, as shown in Movie 8
(https://youtu.be/7cwGg2cSZAE) and summarized in Figure 5.30. The left column in Figure 5.30

shows the activation pattern in sinus rhythm, before spontaneous initiation of VT. The following
beat (VT1) originated from the inferolateral base (asterisk) and triggered the VT. The next beat
(VT2) and all the VT beats that followed (VT2 to VT14) were monomorphic and started from a
different location (superolateral LV base; asterisk) from the triggering beat VT1. ATP pacing

started after 14 beats of VT, at 85% of the VT cycle length. The first ATP beat (P1) consisted of
fusion between the VT wave front (started from *) and the wave front generated by the RV pacing

Figure 5.30. Continuous ECGI of spontaneous VT initiation, continuation, and termination by
antitachycardia pacing (ATP). Epicardial activation maps are shown. See text for description and
Movie 8 (https://youtu.be/7cwGg2cSZAE) for dynamic animation of the entire episode. From
Zhang et. al. [331] with permission of Elsevier.