Case presentation <br />By<br />John KamelZarif<br />lecturer of cardiology<br />Ain-Shams university <br />
61 years old male patient, diabetic, hypertensive, ex-smoker.<br />10 years ago, he suffered from an anteroseptal MI with no reperfusion therapy had been taken.<br />Because of syncopal attack in feb2008, thalium cardiac scan was done which revealed a moderate sized scar in anteroseptal region with no residual viability and minimal peri-infarct ischemia<br />
ECHOcardiography<br />Mildly dilated LV (60X43)<br />Fair LV systolic function, EF = 47%<br />Akinesia of all apical segments, mid septum, mid anterior wall with starting apical aneurysm <br />coronary angiography was done which revealed non-significant LAD lesion <br />
May2008, he suffered from one attack of documented VT which was haemodynamically stable and he had received DC cardioversion.<br />He was kept on amiodarone therapy.<br />Feb2010, another 2 attacks of stable VT had occurred inspite of antiarrhythmic drugs, DC cardioversion were done twice.<br />Mar2010, ICD implanted<br />He received 19 ICD Shocks in one month for frequent recurrent VT inspite of good treatment and no correctable causes.<br />So He was refereed for trial of substrate ablation or modification <br />
Total procedure time: 3 hours<br />Fluoroscopy time: 60 min <br />Complication: none <br />
Take home message <br />Ablation of scar related VT is feasible in the era of 3D CARTO mapping system with more than 70% success rate.<br />Catheter ablation is indicated as adjunctive therapy in patients with structural heart disease and an ICD who are receiving multiple shocks as a result of sustained VT that is not manageable by reprogramming or changing drug therapy or who don’t wish long tem drug therapy( class I, level of evidence: C)<br />Combination of entrainment map with activation map <br /><ul><li>Increases the effectiveness of ablation.
Decreases the complications of unwanted ablation lesions </li></li></ul><li>Thank you<br />
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