Case 3
This was a 16 year old man who was diagnosed with Tetralogy of Fallot. He underwent multiple surgical repairs and received epicardial pacemaker implantation for complete atrioventricular block in 2002. He complained of episodes of sudden onset chest tightness and palpitations. Ventricular tachycardia (VT) was recorded at the emergency room, hence, EPS was done. Venography was performed from the left femoral vein access and showed tortuous left hemiazygous vein with total occlusion from the iliac vein to the proximal inferior vena cava. Vascular access was established in the left internal jugular and subclavian veins. The electroanatomical map of the right ventricle was created using CartoSound module, 3.5mm open-irrigated Thermocool (Thermocool, Biosense Webster, CA, US) ablation catheter and SoundStar catheter. Monomorphic VT was induced during the EPS (Figure 3A). The VT circuit was localized in the area around the tricuspid annulus and right ventricular outflow tract (RVOT) patch. (Figure 3B). Radiofrequency energy was applied at the isthmus of the circuit and eliminated the VT successfully (Figure 3C). Post-ablation inducibility test with RV S1S4 was negative. [13]