title: [Ablation of an idiopathic "ventricular rarity"--ventricular tachycardia originating from the crux cordis].
abstract: METHODS
  A 62-year-old woman presented with history of repeat syncope and palpitations. She experienced aggravation of symptoms within the last few months. At referring hospital a ventricular tachycardia was already inducible during electrophysiological study. The patient was transferred to our hospital for VT ablation vs. ICD implantation.
  
  
  METHODS
  No evidence for structural heart disease was revealed during TTE nor was a coronary heart disease detectable during coronary angiography, only hypertension was verifiable. No ICD implantation so far.
  
  
  METHODS
  The patient underwent repeat EP study at our facility with induction of VT. Pace-mapping and mapping for earliest ventricular activation was performed. The middle-cardiac vein was revealed as site of earliest ventricular activation (50 ms) and good pace-map. Therefore, radiofrequency ablation at this site terminated successfully VT into sinus rhythm.
  
  
  CONCLUSIONS
  Ablation of epicardial VT foci is successfully feasible via coronary sinus. With regard to typical ECG parameters an epicardial foci may be assumed precociously. The great cardiac vein is one of the most common sites of origin for epicardial foci, however, VT partially may originate from the crux cordis which is accessible for ablation via the middle cardiac vein with good ablation results.
authors.affiliation: Herzzentrum der Uniklinik zu Köln, III. Med. Klinik für Kardiologie, Abteilung für Elektrophysiologie.
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Herzzentrum der Uniklinik zu Köln, III. Med. Klinik für Kardiologie, Abteilung für Elektrophysiologie.
authors.forename: J
authors.initials: J
authors.lastname: Lüker
authors.affiliation: Universitäres Herzzentrum Hamburg, Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie.
authors.forename: S
authors.initials: S
authors.lastname: Willems
authors.affiliation: Herzzentrum der Uniklinik zu Köln, III. Med. Klinik für Kardiologie, Abteilung für Elektrophysiologie.
authors.forename: D
authors.initials: D
authors.lastname: Steven
mesh_terms: D017115:Catheter Ablation; D003331:Coronary Vessels / Q000601:surgery; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000601:surgery*