Epicardial RF ablation via the great cardiac vein can successfully eliminate idiopathic mitral annular VT when endocardial ablation fails.
May support epicardial RF via great cardiac vein for refractory mitral annular VT; hypothesis-generating, prospective data needed before practice change.
This case report describes idiopathic ventricular tachycardia (VT) originating from the anterolateral site of mitral annulus. Radiofrequency (RF) energy application at an endocardial site of mitral annulus could not eliminate the tachycardia. The earliest epicardial activation preceding the onset of the QRS complex by 34 ms was found at the great anterior cardiac vein just opposite to the endocardial ablation catheter, pace mapping provided an identical (12/12) match with the VT morphology at the site, and RF ablation effectively eliminated the VT from the great cardiac vein within the coronary venous system.
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Lin et al. (2011) studied this question.
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