Abstract

Ablation of recurrent idiopathic left bundle branch block inferior-axis ventricular tachycardia was performed in a 50-year-old patient. After unsuccessful ablation attempts with an irrigated-tip catheter from the left ventricle (LV) and an anterolateral branch of the coronary sinus at the site of earliest activation, epicardial access and map were obtained. Phrenic nerve stimulation could be induced at the earliest site at the epicardium. To prevent phrenic nerve capture, a stepwise bolus of air (250 mL total) was injected into the pericardial space to separate the epicardium from the nerve, but without success.

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