Successful Substrate-Guided Ablation of Ventricular Tachycardia Storm in Acute Heart Failure Without Mechanical Circulatory Support.
| Title: | Successful Substrate-Guided Ablation of Ventricular Tachycardia Storm in Acute Heart Failure Without Mechanical Circulatory Support. |
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| Authors: | Phuong Tran LU; Section of Cardiac Electrophysiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Nguyen QH; Section of Cardiac Electrophysiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Tran CD; Section of Cardiac Electrophysiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Kieu ND; Section of Cardiac Electrophysiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Vo CN; Section of Cardiac Electrophysiology, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: voch@musc.edu. |
| Source: | JACC. Case reports [JACC Case Rep] 2025 Dec 03; Vol. 30 (39), pp. 106214. |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Inc Country of Publication: Netherlands NLM ID: 101757292 Publication Model: Print Cited Medium: Internet ISSN: 2666-0849 (Electronic) Linking ISSN: 26660849 NLM ISO Abbreviation: JACC Case Rep Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Amsterdam] : Elsevier Inc., [2019]- |
| Abstract: | 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, which may not be available in resource-limited settings.; Case Summary: A 62-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction: 25% to 30%) presented with recurrent monomorphic VT refractory to antiarrhythmic therapy, complicated by hemodynamic instability and multiorgan dysfunction. Mechanical circulatory support was not feasible. Substrate-guided mapping using voltage, late potentials, local abnormal ventricular activity, isochronal late activation mapping, and decrement-evoked potential mapping localized a critical isthmus in the basal posterior left ventricle. Ablation terminated VT and rendered it noninducible 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.; (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
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| Contributed Indexing: | Keywords: acute heart failure; systolic heart failure; ventricular tachycardia |
| Entry Date(s): | Date Created: 20251205 Date Completed: 20251205 Latest Revision: 20260203 |
| Update Code: | 20260203 |
| PubMed Central ID: | PMC12859631 |
| DOI: | 10.1016/j.jaccas.2025.106214 |
| PMID: | 41350024 |
| Database: | MEDLINE |
Case Reports; Journal Article