JACC. Case reports · 2026
Combined Endocardial Pulsed Field: Radiofrequency Ablation of a 3-Dimensional Ventricular Tachycardia With MidMyocardial Isthmus.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Marques Mayara, Cerantola Maxime, Hadjis Alexios
Аннотация
BACKGROUND: Epicardial access for ventricular tachycardia (VT) ablation may be limited in patients with previous cardiac surgery. Substrate depth is a key determinant of ablation success, and deep intramural circuits may not be adequately targeted with conventional endocardial radiofrequency (RF) ablation alone.
CASE SUMMARY: Recurrent VT in a patient with previous cardiac bypass surgery and failed endocardial RF ablation. Mapping demonstrated a midmyocardial isthmus, successfully targeted with VT interruption by using focal combined endocardial pulsed field (PF) and RF ablation.
DISCUSSION: Emerging in vivo evidence suggests that successive PF applications, as well as combined RF-PF ablation, can enhance lesion depth. This case demonstrates immediate VT termination and subsequent noninducibility with successive endocardial PF-RF lesions directly apposed to the far-field midmyocardial/epicardial isthmus, demonstrating the critical depth achieved in real time.
TAKE-HOME MESSAGE: Hybrid RF-PF energy delivery may expand the therapeutic options for complex multiplanar VT circuits when epicardial access is not feasible.
CASE SUMMARY: Recurrent VT in a patient with previous cardiac bypass surgery and failed endocardial RF ablation. Mapping demonstrated a midmyocardial isthmus, successfully targeted with VT interruption by using focal combined endocardial pulsed field (PF) and RF ablation.
DISCUSSION: Emerging in vivo evidence suggests that successive PF applications, as well as combined RF-PF ablation, can enhance lesion depth. This case demonstrates immediate VT termination and subsequent noninducibility with successive endocardial PF-RF lesions directly apposed to the far-field midmyocardial/epicardial isthmus, demonstrating the critical depth achieved in real time.
TAKE-HOME MESSAGE: Hybrid RF-PF energy delivery may expand the therapeutic options for complex multiplanar VT circuits when epicardial access is not feasible.