Evidence of Late Septal Coronary Involvement After Bipolar Radiofrequency Ablation in a Patient With Lamin A/C
Alaa A Shalaby1, Bassem S Hendawy2, Daniel G Wann1
1Division of Cardiac Electrophysiology, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Bipolar radiofrequency ablation effectively controlled ventricular tachycardia in a patient with Lamin A/C cardiomyopathy. This deep septal ablation led to significant myocardial injury and fibrosis, with potential coronary artery effects observed.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pathology
Background:
- Bipolar radiofrequency ablation is gaining traction for deep intramyocardial circuits resistant to unipolar ablation.
- Lamin A/C cardiomyopathy often presents with ventricular tachycardia (VT) originating from the deep interventricular septum.
Background:
Bipolar radiofrequency ablation has been increasingly used in cases with deep intramyocardial circuits refractory to unipolar ablation. Patients with Lamin A/C cardiomyopathy frequently exhibit VT arrhythmia originating from deep in the interventricular septum.
Methods And Results:
We describe our use of bipolar ablation in a patient with nonischemic cardiomyopathy and Lamin A/C mutation for the treatment of a septal VT substrate with particular attention to pathology findings at 3 months.
Conclusions:
Bipolar ablation with catheters across the septum and in the presence of a microcatheter in a septal branch of the anterior interventricular vein was effective in controlling ventricular arrhythmia. Resultant ablation resulted in extensive myocardial injury and fibrosis. Neointimal hyperplasia of intervening coronary arteries may play a role in subsequent effects of initial ablation lesions.
