#AblateVT utilising novel pre-procedural imaging and substrate mapping techniques
⚠️ 66 👱🏼♂️ with recurrent MMVT on amiodarone
🔹 PMHx CABG, mvPCI, Carotid endarterectomy, ICM witb LVEF 25-30%, DC-ICD
1️⃣ Clinical VT exit; LV mid inferolateral (RBBB, - 2,3,avF, - 1,avL, transition V3)
2️⃣ Access; Transeptal and transmitral approach
3️⃣ GA case, no mechanical support
4️⃣ Preprocedural imaging; CT Cardiac with specialised protocol performed recently for coronary assessment utilised as pre-procedural imaging, sent to inHEART.
🫀 Extensive LV inferior and inferolateral scar with calcific changes
🫀 Scar, Wall thinning, Calcification and Fat identified informing ablation strategy
🫀 Assesses coronary/phrenic location
☝🏽1st 🇮🇪 case with inHEART
✍🏽 Strategy; Voltage and LP map with HD catheter (🐙Ray) and merge with inHEART map
🌏 Map in VT with Hd catheter over suspected isthmus
🔥 Dechannel scar (yellow area through scar ➡️ relatively preserved myocardium capable of circuit propagation). Dark red 1mm with yellow thicker tissue
🔥 Any residual VT/unstable VT; DeEP map (see prior post) and ablate suspected substrate
✅ Case performed as above, VT1 and VT2/3 (similar) induced with co-localisation of isthmus (entrainment/activation) to preserved voltage sites within the scar. Non-inducible after ablation
🔥Long ablation times with 50-60W, AI 600-800 performed in some areas due to overlying calcification
⚠️ VT 4 on re-induction. Unstable and rapid. DeEP map identified a suspected circuit through the scar border which after de-channelling was non-inducible
🙅🏾 No VT inducible with triples to VERP 400/220/200/200
Case performed at Mater Misericordiae University Hospital, aided by EP fellow Jenny Carron, with expert mapping from Anthony Kenny (Biosense Webster), support from inHEART with Charlotte Pollmann. Physiologist support in Amanda Elliott and Darren Whelan
Robbie Ryan Charlie O'Kelly Amanda Jones Alice Gilkinson Alan Hanley Thelma Morgan Dr Jonathan Lyne
#AblateVT #Preproceduralmaging #inHEART #MMUH #DeEPmapping