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\begin{document}

\title{Double VTs associated with an anatomical isthmus identified by a
CT-derived channel}



\author[1]{Masateru Takigawa}%
\author[2]{Ruairidh Martin}%
\author[3]{Takeshi Kitamura}%
\author[4]{Hubert Cochet}%
\author[5]{Frederic Sacher}%
\author[1]{Pierre Jais}%
\affil[1]{LIRYC institute, Université de Bordeaux, Centre Hospitalier universitaire de Bordeaux, France}%
\affil[2]{Hopital Haut-Leveque}%
\affil[3]{IHU LIRYC, University of Bordeaux, CHU de Bordeaux}%
\affil[4]{CHU / Université de Bordeaux}%
\affil[5]{Bordeaux University Hospital}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\begin{abstract}
We demonstrated a 47 year-old woman with ischemic-VT with repetitive
ICD-shocks, requiring ablation. Pre-procedural CT demonstrated a single
anatomical channel on the inferior-basal infarcted area between
\textless{}3mm wall thinning area and the mitral annulus, which
suggested the circuit of two VTs observed. Additionally, distribution of
\textless{}2mm and \textless{}3mm scars can explain the mechanism of the
variation of QRS morphology and S-QRS interval during entrainment.
Ablation on this region resulted in no VT- inducibility and absence of
any VTs for 2yrs. CT wall thinning data may allow us to understand the
mechanism and circuit of VT and aid VT ablation procedures.%
\end{abstract}%



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\textbf{Figure legends}

\textbf{Figure 1: ECG and Circuit of clinical VTs}

12-lead ECG of VT1 and VT2 (A). Distribution of wall thinning areas
based on CT (B). VT1 rotates the scar area in clockwise direction (C)
and VT2 rotates clockwisely.

\textbf{Figure 2: Entrainment pacing during VT2}

\textbf{References}

1. Stevenson WG, Sager PT, Friedman PL. Entrainment techniques for
mapping atrial and ventricular tachycardias. J Cardiovasc
Electrophysiol. 1995;6:201--216.

2. de Chillou C, Lacroix D, Klug D, Magnin-Poull I, Marqui\selectlanguage{ngerman}é C, Messier M
et al. Isthmus characteristics of reentrant ventricular tachycardia
after myocardial infarction. Circulation. 2002;105:726-731

3. Bogun F, Li YG, Groenefeld G, Hohnloser SH, Schuger C, Oral H, et al.
Prevalence of a shared isthmus in postinfarction patients with
pleiomorphic, hemodynamically tolerated ventricular tachycardias.

J Cardiovasc Electrophysiol. 2002 Mar;13:237-41.

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