Case report of ventricular tachycardia simulation facilitated ablation for refractory ventricular arrhythmia post-myocardial infarction: aiming before firing.

Background: The management of ventricular arrhythmias (VA) following myocardial infarction presents substantial challenges due to the high morbidity and mortality rates, particularly in cases refractory to medical therapy. In certain cases, the arrhythmogenic anatomical substrate is located in the epicardium. Consequently, achieving a transmural injury by endocardial catheter ablation has always been infeasible.

Case summary: The present describes a case of refractory VA after unsuccessful endocardial ablation associated with a previous myocardial infarction. Consequently, the successful attempts were implemented through transcoronary venous ethanol ablation targeted at the site of epicardial sustained re-entry in the simulation process, generated from cardiac late gadolinium-enhanced magnetic resonance imaging.

Discussion: Ventricular tachycardia simulation guided by cardiac magnetic resonance optimizes ablation strategies for scar-related arrhythmias, while transvenous ethanol ablation serves as a safe alternative when epicardial access is restricted. Further validation is needed to enhance its precision in clinical practice.