Refractory Ventricular Tachycardia-Induced Severe Cardiomyopathy in a Child

BACKGROUND: Ventricular tachycardia (VT)-induced cardiac dysfunction is a recognized but uncommon cause of cardiomyopathy in children. CASE SUMMARY: A 7-year-old girl presented with severely depressed left ventricular function and incessant VT that was refractory to multiple antiarrhythmics and attempted cardioversions. Because of hemodynamic instability, the patient required extracorporeal membrane oxygenation (ECMO) support and ultimately radiofrequency ablation of a focal VT that was localized to the right midventricular septum near the moderator band. The patient had a subsequent return of normal biventricular function. DISCUSSION: Focal VT causing severe dysfunction, unresponsive to both medical therapy and cardioversion, originating from the moderator band of the right ventricle, requiring ECMO support and radiofrequency ablation is extremely rare in the pediatric population, with few reports in the literature. TAKE-HOME MESSAGE: High-risk radiofrequency ablation of unusual focal VT originating from the right ventricular midventricular septum during ECMO may be accomplished with excellent clinical outcomes.