Multiple macroreentrant ventricular tachycardias exhibiting centrifugal endocardial activations from the scar border zone after myocardial infarction

A 53-year-old man with a ventricular tachycardia (VT) electrical storm during the chronic phase of an extensive anteroseptal myocardial infarction underwent electrophysiologic testing and catheter ablation. An electroanatomical map during 7 induced macroreentrant VTs demonstrated multiple centrifugal endocardial activations from sites that were located at the circumferential border zone of a large scar area. Interestingly, during the radiofrequency catheter ablation of 4 of the VTs, the elimination of the substrate of the previous VTs converted one VT to another probably because those VTs might have shared a central common pathway of the macroreentrant circuit with different exits.