[Transvenous ablation of recurrent ventricular tachycardia in arrhythmogenic right ventricular dysplasia]

Catheter ablation was used to cure refractory ventricular tachycardias (VT) in a 20-years old lady with arrhythmogenic right ventricular dysplasia. Antiarrhythmic drugs (procainamide, amiodarone, gilurytmal, flecainide and beta-blockers) used in monotherapy or combination didn't prevent recurrence of sustained VT. During electrophysiological study 3 different morphologies of tachycardia were induced, indicating multiple sites of arrhythmia. One of them was typical for right ventricular outflow tract and similar to the VT recorded in clinical conditions. Endocardial mapping in that region showed pathological low amplitude, fragmented potentials. They preceded by 35 ms the onset of QRS complexes during VT. This area was suggested as a presumed origin of the VT and chosen for transvenous ablation. 11 direct current shock of 200-250 joules (total energy 2400 j) were delivered. No complications were seen during and after ablation. The procedure was terminated when only non sustained VT can be induced by programmed stimulation. The same results were obtained during the control study one month later. However, the patient was taking sotalol and mexiletine. During 6 months period of ambulatory observation the patient was doing well, free of arrhythmias.