title: Successful catheter ablation of epicardial ventricular tachycardia worsened by cardiac resynchronization therapy.
abstract: Soon after an upgrade from a single-chamber implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) with an ICD, a 64-year-old man with non-ischaemic cardiomyopathy began to have increasingly frequent ICD shocks for slow ventricular tachycardia (VT). At electrophysiological study, no clinical VT was induced by endocardial right ventricular pacing, but was easily induced by epicardial left ventricular (LV) pacing via a subxiphoid pericardial approach. The VT was successfully ablated on the LV epicardial surface. This case suggests that epicardial catheter ablation may be an alternative for managing CRT-induced proarrhythmias without the inactivation of LV pacing.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd Avenue S, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Paul B
authors.initials: PB
authors.lastname: Tabereaux
authors.forename: H Thomas
authors.initials: HT
authors.lastname: McElderry
authors.forename: Harish
authors.initials: H
authors.lastname: Doppalapudi
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.forename: Vance J
authors.initials: VJ
authors.lastname: Plumb
authors.forename: G Neal
authors.initials: GN
authors.lastname: Kay
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy