Case 2:
A 79 year-old man with ischemic cardiomyopathy, cardiac resynchronization therapy ICD, and coronary artery bypass graft (CABG) surgery, presented with recurrent VT despite antiarrhythmic drug therapy, three prior endocardial ablation procedures, investigational irrigated intramural needle ablation, and bilateral cervical sympathectomy.11 In preparation for planned surgical epicardial ablation, non-invasive programmed stimulation (NIPS) was performed using his ICD to further characterize the ventricular arrhythmia. During light sedation, NIPS from the RV apical septal lead site with up to 3 extrastimuli down to ventricular refractoriness following drive cycle lengths of 400 and 600 ms failed to induce VT (Figure 2 Panel A). PES was then performed from the lateral LV utilizing the coronary sinus lead, where a pacing drive train of 600 ms without extrastimuli induced sustained monomorphic VT that had a RBBB right axis configuration, consistent with an apical lateral exit from his apical infarct scar (Figure 2 Panel B). VT was terminated with burst pacing. He subsequently underwent surgical epicardial mapping and cryoablation of a large LV epicardial scar, which rendered the VT non-inducible.