Radiofrequency Ablation of Short-Coupled Torsade De Pointes Ventricular Tachycardia: Long Term Result

Aim: To assess the effect of radiofrequency ablation of short-coupled torsade de pointes (TdP) ventricular tachycardia on free from arrhythmia survive in long term follow-up.

Methods and results: Fifty years old female was admitted to the hospital soon after short episode of syncope. Transthoracic echocardiography revealed normal left and right ventricular dimensions and function. The patient’s 12 lead ACG shown normal sinus rhythm. Surface ECG presented short episode of ventricular polymorphic tachycardia induced by short coupled ventricular premature beat (VPB) (240 ms) falling early on the T wave of last sinus beat. Numerous recurrent TdP episodes deteriorated into ventricular fibrillation requiring defibrillation to restore sinus rhythm. All of them started with short coupled VPB (230-280 ms) and shown left superior axis with left bindle branch block type and V5 transition zone presuming right apical septal. Acute treatment of TdP was performed with amiodarone and betaloc. After then dual chamber cardioverter defibrillator was implanted.

The patient was referred for ablation of the ectopic focus likely to be a mechanism of abnormal automaticity or triggered activity. Activation mapping suggested the earliest signal in the lower part of RV IVS. Spontaneous clinical VPB occurred 26 ms before surface ECG QRS. Initial sharp potential represented a peripheral Purkinje component during sinus rhythm in the point of VPB onset. Pace mapping revealed 92% match in this area and advance of the Purkinje potential when accelerated ventricular rhythm during radiofrequency ablation. The patient was maintained on bisoprolol and over 2 years (30 month) follow up has not had any ventricular arrhythmias from ICD monitor.

Conclusion. The effectiveness of radiofrequency ablation was confirmed by the device memory over 2 years of follow up