Key result
Pacing maneuvers from a permanent epicardial left ventricular lead successfully identified an epicardial ventricular tachycardia origin, enabling targeted surgical cryoablation that eliminated the VT.
Why the study?
Does pacing from a permanent epicardial left ventricular pacing lead identify epicardial VT origin in patients with prior cardiac surgery?
Case Report (n=1)
Does pacing from a permanent epicardial left ventricular pacing lead identify epicardial VT origin in patients with prior cardiac surgery?
Pacing maneuvers from permanent epicardial leads can help identify an epicardial VT origin when prior surgery prevents percutaneous epicardial mapping.
May aid VT localization when percutaneous access is limited; leaves open prospective validation before wider adoption.
Entrainment From Left Ventricular Pacing Lead. Recognizing ventricular tachycardias (VTs) that require epicardial ablation is desirable, but challenging when prior surgery prevents percutaneous epicardial mapping. This patient had cardiomyopathy, prior cardiac surgery, and VT that failed endocardial ablation. Observing that the Bi-V implantable cardioverter defibrillator (ICD), left ventricular (LV) lead was epicardial to the area of infarct scar, it was used to pace during VT. Entrainment with concealed fusion with long stimulus to QRS interval, consistent with an epicardial VT circuit, was observed. Surgical cryoablation targeting the area around the LV lead eliminated VT. Thus pacing maneuvers from permanent epicardial leads can occasionally help identify an epicardial VT origin.
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Inada et al. (2010) conducted a case report in Ventricular tachycardia (n=1). Pacing from permanent epicardial left ventricular lead was evaluated on Elimination of ventricular tachycardia. Pacing maneuvers from a permanent epicardial left ventricular lead successfully identified an epicardial ventricular tachycardia origin, enabling targeted surgical cryoablation that eliminated the VT.
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