Successful LV Summit Ablation: Elimination of Idioventricular Rhythm With Half-Normal Saline and Anterior Patch

Catheter ablation of arrhythmias from the left ventricular (LV) summit are often challenging because of anatomical inaccessibility and proximity to coronary arteries.

A 43-year-old man with recurrent arrhythmia-induced cardiomyopathy presented with the accelerated idioventricular rhythm. With earliest activation (preceding QRS onset by 63 ms) in the anterior interventricular vein, catheter ablation from the LV outflow tract and the left coronary cusp was unsuccessful. Catheter ablation using half-normal saline irrigation with an anterior dispersive patch successfully eliminated the accelerated idioventricular rhythm.

This case illustrates the potential role of adjunctive approaches in overcoming anatomical barriers to LV summit ablation. The use of half-normal saline irrigation and anterior patch-assisted ablation demonstrated efficacy where conventional methods were insufficient.

Advanced radiofrequency ablation strategies, including modified irrigation and patch-assisted delivery, may enable safe and effective treatment of complex LV summit arrhythmias, thereby reducing reliance on more invasive or higher risk interventions.