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]