Epicardial Ablation as a Treatment of Recurrent Ventricular Tachycardia Originating From a Left Ventricular Aneurysm: A Case Report and Review of the Literature

Catheter ablation (CA) is an important therapeutic modality for the management of ventricular tachycardia (VT). In some patients, CA may be ineffective because of the inability to reach the effective target site from the endocardial surface. Partly, this is due to the effect of the transmural extent of the myocardial scars. The operator's ability to map and ablate the epicardial surface has enhanced our understanding of scar-related VT in various substrate states. A left ventricular aneurysm (LVA) that develops after myocardial infarction may increase the risk of VT. Endocardial ablation alone of LVA may be insufficient in preventing recurrent VT. Numerous studies have demonstrated greater freedom from recurrence with adjunctive epicardial mapping and ablation via a percutaneous subxiphoid technique. Currently, epicardial ablation is performed predominantly at high-volume tertiary referral centers via the percutaneous subxiphoid approach. In this review, we first report a case of a man in his 70s with ischemic cardiomyopathy, a large apical aneurysm, and recurrent VT status post-endocardial ablation who presented with incessant VT. The patient underwent successful epicardial ablation over the apical aneurysm. Second, our case showcases the percutaneous approach and underscores its clinical indications and potential complications.