PO-04-029 TRIANGULATING THE LV SUMMIT: A NOVEL BIPOLAR RADIOFREQUENCY CATHETER ABLATION STRATEGY

Bipolar radiofrequency catheter ablation (RFCA) is an off-label strategy used to target ventricular arrhythmias (VA) from difficult substrates such as the LV summit. To achieve greater transmural RFCA lesions in challenging anatomy with a novel bipolar strategy. N/A A 51-year-old male familial HCM and prior for persistent AF presented pallor palpitations setting of wide complex tachycardia 210 BPM (Figure A). The patient was given bolus IV amiodarone externally cardioverted. Amiodarone discontinued his history amiodarone-induced hyperthyroidism. During hospitalization, he had recurrences sustained VAs that were suppressed lidocaine. Cardiac MRI obtained, which showed LVEF 42% extensive LGE B). brought EP lab VT ablation. Extensive mapping RVOT, distal CS, peri-aortic area performed. best pacemap achieved 2F EPstar (Baylis Medical) AIV. not able be advanced into branch coronary sinus. total 17 unipolar delivered endocardial but clinical VA remained easily inducible. second posteroseptal RVOT on opposite side septum RFCA. positioned AIV near region tripolar effect C). significant difference impedance decline noted between ablations utilizing this D top - unipolar, bottom bipolar). Following five RCFA lesions, no longer tolerated procedure well further recurrence VAs. triangulating may help deeper lesions.