Catheter ablation targeting triggering PVCs can be an effective strategy to prevent recurrent pleomorphic VT in patients with prior myocardial infarction.
Supports ablation of triggering PVCs in post-MI pleomorphic VT; hypothesis-generating and requires prospective validation.
A 50-year-old man who had suffered from old myocardial infarction presented with an episode of syncope. DC shock was required for the interruption of frequent pleomorphic ventricular tachycardia (VT). Although the treatment for heart failure decreased the frequency of VT attacks, hemodynamically unstable VT occurred several times. A 12-lead Holter electrocardiogram was used to determine the triggering premature ventricular contraction (PVC) and catheter ablation was performed by targeting this PVC. The site of origin of the triggering PVC was considered to be located between damaged cardiac muscle and intact Purkinje's fiber. No episode of PVC and VT was observed after a few days of ablation. An implantable cardioverter defibrillator was implanted but VT did not recur for more than 20 months.
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Kato et al. (2006) studied this question.
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