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LV Summit VT Ablation — EECC MCQ

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HardArrhythmia & ElectrophysiologyLV Summit VT AblationEECC

A 45-year-old man with a structurally normal heart presents with sustained monomorphic VT originating from the LV summit (confirmed on EP study). Catheter ablation from both the endocardial and epicardial approach fails to eliminate the arrhythmia. What alternative ablation approach may be considered?

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Correct answer: A — Ablation from within the coronary venous system (great cardiac vein/anterior interventricular vein) or via the left coronary cusp

The LV summit is an anatomically challenging area for ablation, located at the most superior portion of the LV epicardium, bounded by the LAD, the great cardiac vein/AIV, and the left coronary cusp. Standard endocardial and percutaneous epicardial approaches may fail due to: proximity to coronary arteries (risk of coronary injury), epicardial fat insulating the substrate, and anatomical inaccessibility. Alternative approaches include ablation from within the coronary venous system (great cardiac vein, AIV — using irrigated radiofrequency or alcohol infusion), from the aortic left coronary cusp, or bipolar ablation between endocardial and venous catheter positions. These advanced techniques require specialised electrophysiology expertise.

Reference: EHRA Consensus on Catheter Ablation of VT