PO-04-054 FIRST REPORTED HUMAN CASE OF ELECTRICAL STORM TREATED WITH THE NEW HIGH-POWER-SHORT-DURATION TACTIFLEXTMABLATION CATHETER.

Abstract

In the last decade, standard-power-long-duration radiofrequency delivery systems were the standard care to treat ventricular arrhythmias. Recently, high-power-short-duration radiofrequency delivery systems are available and TactiFlexTM Ablation Catheter is the most recent one. we present the first worldwide case of electrical storm catheter ablation using the new TactiFlexTM. N/A A 78 years old female was admitted to the emergency department because of arrhythmic storm. Thirty days earlier she had been hospitalized for acute coronary syndrome. On initial assessment, she appeared soporous, arterial blood pressure was 80/50 mmHg and ECG revealed sustained monomorphic ventricular tachycardia, regular cycle length, left bundle branch morphology, negative concordance in precordial lead. Patient therapy included metoprolol, mexiletine and cordarone; intravenous lidocaine and procainamide were added, with poor results in controlling arrhythmia; then, we decide to perform VT catheter ablation. Left ventricle mapping was performed with TactiFlexTM and AdvisorTM HDGrid Mapping Catether supported by the new EnsiteX V2 electro-anatomical mapping system and Omnipolar Technology. During voltage substrate mapping we found a central necrotic core area surrounded by a low voltage area in the mild-apical posterior-lateral wall. During late potential mapping the same area showed late and multi-fragmented potentials. Clinical tachycardia was easily induced during programmed ventricular pacing. VT activation map was performed and no meso-diastolic potentials or "early meets late" areas were found, probably signifying a possible epicardial regions involvement in the VT circuitry: it was not possible to reconstruct the entire arrhythmia circuit. Activation velocity map was performed and VT slowed in the same regions of low voltage and fragmented potentials. High-power radiofrequency energy (35W-25seconds or 40W-20seconds pulses) was delivered in the mid-basal posterior-septal wall obtaining VT termination. Subsequently, substrate homogenization, which include late and fragmented potentials elimination, was performed. No ventricle arrhythmias were inducible during programmed ventricular pacing. No procedure-related complications occurred. TactiFlexTM appears safe and effective to control left VT. Further reports and studies are needed to evaluate the most appropriate Watts and seconds to perform effective and safe human left ventricle injuries.