Successful bailout of refractory ventricular fibrillation originating from the moderator band using bipolar ablation in a patient with short-coupled variant of torsade de pointes

A 33-year-old woman was transferred to our institute with ventricular fibrillation (VF) after a few beats of torsade de pointes (TdP), which was suppressed with intravenous infusion of verapamil. The patient underwent implantable cardioverter-defibrillator implantation due to short-coupled variant of TdP. However, an electrical storm of VF recurred. Catheter ablation targeting the trigger premature ventricular contraction (PVC) with a left bundle branch block morphology and left axis deviation, where the earliest activation was recorded at the lateral aspect of the apex of the right ventricle. Neither TdP nor VF occurred at the end of the procedure. However, the VF recurred after the index procedure, and a repeat procedure was performed (Panel A). The earliest activation site was similar to that at the index procedure, 32 ms earlier than the QRS onset (Panel B). Intracardiac echocardiography showed that the ablation catheter was located at the free-wall insertion...