Successful, urgent, single-stage endo-epicardial catheter ablation with a surgically subxiphoid pericardial window for a drug-resistant ventricular tachycardia storm in an extremely old hemodialysis patient with ischemic cardiomyopathy

Figure 1. A: Twelve-lead electrocardiogram of ventricular tachycardia (VT). B: Fluoroscopic image of the ablation site. C: Entrainment with concealed fusion. The postpacing interval was 372 ms, which was almost consistent with VT cycle length, and the S-QRS interval was 112 ms. D: VT was terminated approximately 4.5 seconds after initiating radiofrequency application. E: The difference between sinus rhythm and coronary sinus posterolateral branch pacing in ablation catheter potentials.

Figure 2. A: Electroanatomical endocardial mapping by coronary sinus (CS) posterolateral vein pacing. Isochronal late activation mapping (ILAM). B: Electroanatomical epicardial mapping by CS posterolateral vein pacing. ILAM. C: Electroanatomical epicardial mapping during sinus rhythm. Left: ILAM; right: voltage map. D: Postablation electroanatomical epicardial mapping during sinus rhythm. Left: ILAM; right: voltage map.

Figure 3. A: Surgical epicardial exposure is shown. A 2-inch vertical incision was made at the subxiphoid area, and an 8.5F deflectable sheath was inserted into the pericardial space. B: The surgical wound was sutured after insertion of the pericardial drainage tube.