Clinical Electrophysiology -> Ventricular Arrhythmias -> Mapping & Imaging D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-052 - Deep Basal-intraseptal Ventricular Tachycardia Due To Sarcoidosis Treated With MUSIC-Guided Irrigated Needle Catheter Ablation (ID 684)

Abstract

Background: Catheter ablation for ventricular tachycardia (VT) can be challenging in nonischemic cardiomyopathy.
Objective: We describe a case of deep intraseptal VT targeted with irrigated needle radiofrequency (RF) ablation assisted by MUSIC guidance (Liryc, Bordeaux, Fr).
Results: The patient was a 55 y.o. male with cardiac sarcoidosis, preserved LVEF, complete heart block, CRT-D, and recurrent VT. He underwent catheter ablation due to shocks despite amiodarone; 2 VT were induced with exits below the left-right coronary cusp commissure and septal RVOT. 4 months post ablation, ATP-terminated VT recurred. At repeat catheter ablation, the induced VT showed a basal periaortic exit correlating to intramural scar seen on cardiac CT, displayed with MUSIC (Panel A). Excellent pace-maps were found just ventricular to the right coronary cusp, at sites with long and low amplitude fractionation. Despite RF ablation 30-50W from both sides of the septum, rendering loss of endocardial capture at 10mA and 9ms output, the same VT remained inducible (Panel B). Under intracardiac echocardiography (ICE), irrigated needle RF ablation was performed via a transseptal approach. Needle deployment and contrast injection at the site of prior best pace-map caused impressive contrast staining and hypoechoic infiltration(Panel C,D). Excellent power delivery created a large hyperechoic intramural lesion, displayed with cardiosound (Panel D, brown), rendering the clinical VT non-inducible with 3 extrastimuli.
Conclusion: Multimodality imaging assisted with MUSIC was helpful in deep intraseptal substrate identification, enabling effective and targeted irrigated needle RF ablation.
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