Background: Ventricular tachycardia (VT) storm in advanced systolic heart failure carries high morbidity and mortality. Ablation is often performed with advanced imaging and mechanical circulatory support (MCS), which may be unavailable in resource-limited settings.
Case Summary: A 62-year-old man with ischemic cardiomyopathy (LVEF 25-30%) presented with recurrent monomorphic VT refractory to antiarrhythmic therapy, complicated by hemodynamic instability and multiorgan dysfunction. MSC was not feasible. Substrate-guided mapping using voltage, late potentials, local abnormal ventricular activity (LAVA), isochronal late activation mapping (ILAM) and decrement-evoked potential mapping (DeEP) localized a critical isthmus in the basal posterior left ventricle. Ablation terminated VT and rendered it non-inducible under monitored anesthesia care with norepinephrine and low-dose dobutamine.
Conclusion: Functional substrate mapping with limited intra-VT mapping and tailored anesthesia enabled procedural stability and successful VT ablation.
Take-Home Message: Substrate-guided mapping with individualized hemodynamic support can achieve safe, effective VT ablation in resource-limited settings.
JACC Case Reports Interim Editors-in-Chief
Gilbert H. L. Tang, MD, MSc, MBA
CME Editor
Kenneth A. Ellenbogen, MD
Author
José Ángel Cabrera, MD
Important Dates
Date of Release: December 3, 2025
Term of Approval/Date of CME/MOC Expiration: December 2, 2026