Key result
Prolonged high-power ablation from the endocardium may create deeper lesions to target remote epicardial locations across the myocardial wall.
Case Report (n=1)
Prolonged high-power endocardial ablation can create deeper lesions to target epicardial VT substrates when epicardial ablation is limited by anatomy.
May enable endocardial targeting of epicardial VT when access is limited; hypothesis-generating case report requiring validation.
Tabled 1KEY TEACHING POINTS•The mechanism of ventricular tachycardia in patients with structural heart disease is most frequently macroreentrant. However, many patients with a myocardial scar have focal mechanisms and a careful analysis of entrainment can be helpful in determining the most desirable timing of the successful ablation site.•Epicardial ablation is frequently limited by close proximity to coronary arteries and epicardial adipose tissue. Alternative strategies and technologies are needed to address these substrate locations.•Prolonged high-power ablation from the endocardium may create a deeper lesion to target remote locations across the myocardial wall, and early termination should not be expected during radiofrequency delivery in such cases. Optimal biophysical parameters require further clarification to maintain safety. Open table in a new tab
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Romero et al. (2015) conducted a case report in Epicardial microreentrant ventricular tachycardia with nonischemic cardiomyopathy (n=1). Prolonged high-power endocardial ablation was evaluated. Prolonged high-power ablation from the endocardium may create deeper lesions to target remote epicardial locations across the myocardial wall.
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