ArticleJACC. Case reports2025
Successful Substrate-Guided Ablation of Ventricular Tachycardia Storm in Acute Heart Failure Without Mechanical Circulatory Support.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVentricular tachycardia (VT) storm in advanced systolic heart failure carries high morbidity and mortality. Ablation is often performed with advanced imaging and mechanical circulatory support, which may not be available in resource-limited settings. CASE SUMMARY: A 62-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction: 25% to 30%) presented with recurrent monomorphic VT refractory to antiarrhythmic therapy, complicated by hemodynamic instability and multiorgan dysfunction. Mechanical circulatory support was not feasible. Substrate-guided mapping using voltage, late potentials, local abnormal ventricular activity, isochronal late activation mapping, and decrement-evoked potential mapping localized a critical isthmus in the basal posterior left ventricle. Ablation terminated VT and rendered it noninducible under monitored anesthesia care with norepinephrine and low-dose dobutamine.
conclusionFunctional substrate mapping with limited intra-VT mapping and tailored anesthesia enabled procedural stability and successful VT ablation. TAKE-HOME MESSAGE: Substrate-guided mapping with individualized hemodynamic support can achieve safe, effective VT ablation in resource-limited settings.
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