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.