3 Year outcome of successful epicardial-endocardial catheter ablation of sustained reentrant monomorphic ventriculartachycardia in hypertrophic cardiomyopathy patient

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Conference Proceeding

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Publication Title

J Interv Card Electrophysiol


Background: Reentry based sustained monomorphicventricular tachycardia (SMVT) is rare in patients with hypertrophic cardiomyopathy (HCM).We present a case ofsuccessful endocardialepicardial ablation of drug refractory SMVT in a patient with HCM with recurrent defibrillator shocks. Objective: To describe re-entrant scar related monomorphic VT in a HCM patient and successfulmanagement with epicardial ablation Methods: N/A Results: A 63-year-old African-American male with nonobstructive HCM, hepatitis C, paroxysmal atrial fibrillation was evaluated for recurrent ICD shocks for SMVT refractory to disopyramide and amiodarone. Twelve lead ECG during VT storm showed a RBB, left superior axis VT which was not amenable to pace termination from the device at multiple cycle lengths. Endocardial 3D mapping during VT showed bystander sites. After obtaining sub-xyphoid epicardial access, entrainment mapping revealed a large diastolic isthmus corridor in the apicolateral left ventricle where ablation using an irrigated catheter led to termination. Patient had to be taken back to laboratory 24 h later for a slower SMVTwhere re-domapping in the epicardium did not reveal anymid-diastolic potentials. Endocardial mapping showed entry site opposite to epicardial ablation site where ablation led to VT termination. Amiodarone was discontinued 3 months post ablation and patient has been arrhythmia free 2 years post ablation. Conclusions: Scar-related re-entrant sustainedmonomorphic VT can present as VT storm in HCM patientwith successful long-term catheter ablation results, targeting endocardial and epicardial isthmuses defined using classing entrainment mapping techniques.





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