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Epicardial-Endocardial Reentry in Ischemic Cardiomyopathy
Yasuhito Kotake1,2, Chrishan J Nalliah1,2, Timothy Campbell1,2
1Department of Cardiology, Westmead Hospital, Sydney, Australia.
Summary
Epicardial involvement is crucial for ventricular tachycardia (VT) in ischemic cardiomyopathy, challenging traditional endocardial reentry models. This case highlights a novel 3D VT reentry with epicardial origins and an endocardial exit.
Area of Science:
- Cardiovascular Physiology
- Cardiac Electrophysiology
- Myocardial Pathophysiology
Background:
- Traditionally, endocardial reentry has been the accepted mechanism for ventricular tachycardia (VT) in ischemic cardiomyopathy.
- Emerging evidence suggests the epicardial myocardium plays a significant role in VT substrate, even in ischemic conditions.
Observation:
- This report details a unique case of a three-dimensional (3D) VT reentry.
- The reentry circuit involved critical epicardial components.
Findings:
- The observed VT reentry demonstrated an epicardial origin.
- The circuit concluded with an endocardial exit.
Implications:
- This finding expands the understanding of VT mechanisms in ischemic cardiomyopathy.
- It suggests that epicardial substrate should be considered in the diagnosis and treatment of VT.
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