https://orcid.org/0000-0001-7274-4541
A 78-year-old man with a previous anterior myocardial infarction was referred to our Department after a cardiac arrest due to ventricular tachycardia (VT) episodes. He underwent implantable cardioverter defibrillator implantation, and, due to the presence of a thrombus in the apex, an epicardial-only ablation was planned. Electrophysiology study induced a monomorphic sustained VT (Cycle 530 ms, left bundle branch block (LBBB) morphology with superior axis) and activation mapping showed mid-diastolic signals in the inferoseptal apical region (Panel A), where radiofrequency was able to terminate the tachycardia, which was non-inducible afterwards (Supplementary material online). However, the patient suffered after 2 months from further incessant VT recurrences (Cycle 560 ms, LBBB morphology with inferior axis), despite treatment with amiodarone (Supplementary material online). Firm apical adherences, already described at the first procedure, did not allow to reach the isthmus in the second epicardial mapping. We therefore opted for stereotactic radioablation of the apical substrate. A CT scan of the left ventricle was re-elaborated using specific software (Panels B and C) to identify the CT-channels, defined as channel-shaped edges inside the CT scar. Irradiation (25 Gy) included two CT-channels, whose location was concordant with the exit site of previously documented VTs identified from a QRS-axis based algorithm (Panel D). There were no acute complications and no recurrences at 6-months follow-up.
The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
Supplementary material is available at Europace online.
