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Case presentation . By John Kamel Zarif 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.
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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
VT2 VT1
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