Transcoronary mapping and chemical ablation of ventricular tachycardia in no-entry left ventricle

Publication date: Available online 22 August 2019Source: Journal of Cardiology CasesAuthor(s): Shohei Kataoka, Ken Kato, Hiroyuki Tanaka, Tamotsu TejimaAbstractIt is challenging to perform ablation of ventricular tachycardia (VT) from the left ventricle (LV) in patients without catheter access to the LV. A 50-year-old man was referred to our hospital for VT. He underwent mechanical aortic and mitral valve replacement for infective endocarditis and embolic myocardial infarction in the left ventricular inferior wall during a surgery. Anti-arrhythmia drugs (AADs) such as sotalol and bisoprolol were initiated and implantable cardioverter defibrillator was implanted. However, 2 months after discharge, he was admitted again for cardiac implantable electronic device (CIED) infection and underwent complete CIED system removal. During hospitalization, VT easily occurred despite the use of AADs. We decided to perform transcoronary chemical ablation to treat this drug-refractory VT. A 0.014-inch guide-wire and a micro-catheter were advanced into coronary arteries. Pace map was conducted using a guide-wire and the micro artery branch feeding the VT exit area was detected. Ethanol infusion to this branch and the slightly basal side of the area eliminated the VT. We successfully treated VT in the no-entry LV by wire-guided mapping and ethanol ablation via coronary arteries. VT has not recurred during the follow-up period of 12 months.
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research

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