Ventricular Tachycardia Ablation in a Case of Calcified Left Ventricular Apical Aneurysm

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Calcific left ventricular (LV) apical aneurysms are a known source of ventricular arrhythmias.
• Dense calcification presents significant challenges for electroanatomic mapping and catheter ablation due to signal attenuation and catheter instability.

Purpose of the Study:

• To report a successful catheter ablation of antiarrhythmic drug-refractory ventricular tachycardia (VT) originating from a calcified LV apical aneurysm.
• To highlight the utility of intracardiac echocardiography (ICE) and 3D electroanatomic mapping in managing complex arrhythmogenic substrates.

Main Methods:

• Utilized 3D electroanatomic mapping with high-density substrate mapping to identify arrhythmogenic substrate.
• Employed intracardiac echocardiography (ICE) for enhanced visualization and catheter guidance during ablation.
• Performed targeted catheter ablation of critical isthmus channels identified by fragmented late potentials.

Main Results:

• Successful termination of VT during the procedure.
• Noninducibility of VT after targeted ablation.
• Identification of fragmented late potentials bordering calcified zones as critical for VT maintenance.

Conclusions:

• Catheter ablation guided by ICE and 3D electroanatomic mapping is an effective treatment for VT in calcific LV apical aneurysms.
• High-density substrate mapping can delineate critical conduction channels within complex calcified substrates.
• This approach offers a viable solution for patients with drug-refractory VT associated with these challenging anatomical abnormalities.