Case presentation By John KamelZarif lecturer of cardiology Ain-Shams university
61 years old male patient, diabetic, hypertensive, ex-smoker. 10 years ago, he suffered from an anteroseptal MI with no reperfusion therapy had been taken. 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
ECHOcardiography Mildly dilated LV (60X43) Fair LV systolic function, EF = 47% Akinesia of all apical segments, mid septum, mid anterior wall with starting apical aneurysm coronary angiography was done which revealed non-significant LAD lesion
May2008, he suffered from one attack of documented VT which was haemodynamically stable and he had received DC cardioversion. He was kept on amiodarone therapy. Feb2010, another 2 attacks of stable VT had occurred inspite of antiarrhythmic drugs, DC cardioversion were done twice. Mar2010, ICD implanted He received 19 ICD Shocks in one month for frequent recurrent VT inspite of good treatment and no correctable causes. So He was refereed for trial of substrate ablation or modification
Total procedure time: 3 hours Fluoroscopy time: 60 min Complication: none
Take home message Ablation of scar related VT is feasible in the era of 3D CARTO mapping system with more than 70% success rate. 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) Combination of entrainment map with activation map
Increases the effectiveness of ablation.
Decreases the complications of unwanted ablation lesions