Catheter ablation of idiopathic ventricular fibrillation using the CARTO 3 mapping system

Ventricular fibrillation in the absence of structural heart disease represents an important mechanism of sudden cardiac death. It is initiated by triggers originating in the distal Purkinje fibers, arising from either the right or the left ventricle. Catheter ablation of these triggers has the potential of terminating the arrhythmia and preventing recurrence. We present the case of an electrical storm in a 39-year old female patient with no cardiac past medical history, with recurrent episodes of idiopathic ventricular fibrillation, who was referred to our hospital for repeated episodes of syncope. The 12-lead ECG showed the presence of frequent ventricular premature beats (VPB), having a left-bundle branch block morphology and superior axis, with an “R on T” phenomenon, initiating non-sustained episodes of ventricular fibrillation. Using a three-dimensional, non-fluoroscopic mapping system (CARTO 3, Biosense Webster), the origin of the ventricular premature beat responsible for the initiation of VFib was identified and successfully ablated. Catheter ablation of idiopathic ventricular fibrillation using a 3-dimensional mapping system is a feasible therapeutic option for patients with this type of arrhythmia.