Mini-electrodes help identifying hidden slow conduction during ventricular tachycardia substrate ablation

A 69-year-old male with dilated non-ischemic cardiomyopathy and history of sustained monomorphic VT (SMVT) underwent an unsuccessful VT substrate ablation due to the proximity of the earliest activation site to the conduction system. A second attempt was performed using an ablation catheter with mini-electrodes (ME) and multiple extrastimuli to unveil hidden slow conduction (HSC) sites, allowing the performance of a successful ablation. No SMVT was induced thereafter. ME-obtained electrograms permit to accurately localize areas of HSC sites within ventricular tachycardia (VT) substrates. In our case, this allowed safe ablation during sinus rhythm to eliminate the VT substrate.