Surgical cryoablation guided by electroanatomic mapping and a radiofrequency landmark can successfully treat refractory VT storm originating from the interventricular septum during concomitant valve surgery.
May inform hybrid ablation planning in refractory septal VT before valve surgery; leaves open need for systematic evaluation.
A 58-year-old man with dilated cardiomyopathy was admitted with heart failure. He had a history of two catheter ablation procedures for ventricular tachycardia (VT) originating from the intraventricular septum (IVS). Before dual valve replacement (DVR), he suffered a VT storm. An electrophysiological study revealed an extended low-voltage area at the IVS with the exit of the induced VT at the anterior side. Radiofrequency application was performed at the VT exit as a landmark for surgical cryoablation (SA). During the DVR, SA was performed at the IVS using this landmark. After SA, the patient had no ventricular tachyarrhythmia.
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Kawamura et al. (2017) studied this question.
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