Catheter Ablation of Ventricular Tachycardia in LMNA Cardiomyopathy: Out
of Sight but not Out of Mind
Abstract
Lamin Cardiomyopathy (LC) is associated with refractory ventricular
arrhythmias. Catheter ablation success rate is low due to presence of
multiple circuits and intramural substrate. We present a LC case
presented with electrical storm. During catheter ablation, arrhythmia
was easily inducible but activation mapping, including full epicardial
and endocardial mapping, failed to demonstrate the full tachycardia
cycle length (70% only) suggesting intramural activation. Critical
isthmus was not identified even with successful concealed entrainment on
both Endo/epicardial surfaces. This case shows that even combined
endocardial and epicardial catheter approach can be ineffective in
identifying the full arrhythmogenic substrate in LC.