[Nonischemic ventricular tachycardia with coronary arterio-venous fistula]

A 22 year-old man who suffered ventricular tachycardia (VT) during 8 years was admitted to our hospital for treatment of VT. He also had diseased, coronary arterio-venous fistula with a mild L-R shunt and coronary fistula was closed operatively 4 years ago because it was presumed to be a cause of VT, but the VT remained after the closing on the fistula. After admission in our hospital, catheter endomyocardial mapping and coronary cineangiography were undergone and revealed that the coronary artery was intact and a pre-excitation area located in the LV apico-lateral wall. Dual catheter ablations were attempted but resulted in failure. Then, surgical cryoablation was employed under the use of extracorporeal circulation, following epicardial and endocardial mapping. Cryoablation (-150 degrees C) to the postero-septal wall of LV could terminate VT completely.