Abstract
We report an alternative technique for mapping and ablation of hemodynamically untolerated ventricular tachycardia (VT) in a patient with ischemic cardiomyopathy. The patient presented with a history of recurrent ICD shocks for monomorphic VT despite amiodarone therapy. At electrophysiologic study sustained monomorphic VT (cycle length 515 ms) was reproducibly inducible. During VT systolic blood pressure decreased from 145/71 to 54/41mmHg and remained depressed. With LV mapping during right atrial (RA) pacing we could easily identify a large posterolateral infarct with dense scar and interspersed channels of surviving myocardium (demonstrated by isolated late potentials).
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