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Catheter Ablation of Ventricular Tachycardia in LMNA Cardiomyopathy: Out of Sight but not Out of Mind
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  • Ahmad Halawa,
  • Paul Zei,
  • Neal Lakdawala,
  • William Sauer,
  • Usha Tedrow,
  • Sunil Kapur
Ahmad Halawa
Brigham and Women's Hospital Carl J and Ruth Shapiro Cardiovascular Center

Corresponding Author:amhalawa@hotmail.com

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Paul Zei
Brigham and Women's Hospital
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Neal Lakdawala
Brigham and Women's Hospital Carl J and Ruth Shapiro Cardiovascular Center
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William Sauer
Brigham and Women's Hospital Carl J and Ruth Shapiro Cardiovascular Center
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Usha Tedrow
Brigham and Women's Hospital
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Sunil Kapur
Brigham and Women's Hospital
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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.