PO-01-084 HIDING IN PLAIN SIGHT

Substrate based scar modification requires accurate detection and characterization of myocardial in sinus rhythm or using different wavefronts activation. Mapping during ventricular tachycardia can be performed only about 30% to 40% cases. We describe a challenging case VT with discrepancy the delineation between voltage mapping cardiac MRI role Decremental Evoked Potential as guide more focussed ablation such circumstances. N/A 56 year diabetic female status post Coronary artery bypass grafting 2016 moderate left dysfunction recurrent episodes hemodynamically unstable patient's refusal for ICD was evaluated revealed subendocardial anterior wall patent grafts on coronary angiogram. Patient taken up 3D 3.5 mm tip non force sensing unidirectional irrigation catheter.In view VT, activation not possible, hence substrate planned. Endocardial bipolar didnot delineate any after changing wavefront right paced rhythm. Unipolar map show scar. While , abnormal local electrograms were seen superimposed into far field electrograms. To do foccussed we applied concept identified slow conduction zone - most critical component initiation maintainence re-entry. ablated points absolute value decrement than 10 ms part zone. Post ablation, inducible despite induction protocol triple extrastimuli from two sites. Activation is possible VT. needs As system an automated annotates largest amplitude signals color coded mapping, cases without dense scar, doesnot reliably identify when compared MRI, particularly larger diameter catheter. Novel techniques like enable limited