B-po02-210 inferred intramural activation facilitated by epicardial and endocardial activation mapping during ventricular tachycardia in lamin cardiomyopathy

Lamin Cardiomyopathy (LC) is a progressive dilated cardiomyopathy with associated atrial and ventricular arrhythmias as well as AV block. Success rates with catheter ablation are low due to presence of multiple VT circuits and intramural substrate. We present a case of an LC patient who presented with electrical storm manifest as incessant ventricular tachycardia (VT). N/A A 50-year-old male with LC, NYHA class III heart failure with LVEF 45%, history of atrial fibrillation, left bundle branch block, and sudden cardiac arrest presented with slow VT requiring manual anti-tachycardia pacing in the emergency department. He was taken to VT catheter ablation where VT was easily inducible. Activation mapping during VT failed to include the full tachycardia cycle length (70% only) suggesting intramural activation. We performed complete epicardial and endocardial mapping and demonstrated concealed entrainment. Endocardial ablation lesions in the left/right ventricles and on the opposite epicardial space were applied utilizing high power radiofrequency power with half normal saline. Despite brief early VT recurrence within four weeks of ablation, he was successfully weaned off his anti-arrhythmia medications 5 months later. Even combined endocardial and epicardial catheter approach can be ineffective in identifying the full arrhythmogenic substrate in LC. In this case, catheter ablation with half normal saline was successful despite significant mid-diastolic intramural activation. Careful planning with targeting mid-myocardium may optimize chances of successful catheter ablation.