A Case of Ventricular Tachycardia with Dilated Cardiomyopathy Controlled by D-Sotalol and Catheter Ablation

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A 76-year-old man, with previous history of dilated cardiomyopathy and ventricular tachycardia treated with amiodarone was admitted to our hospital because of intestitial pneumonia. After discontinuation of amiodarone, VT was occurred frequently. VT’s cycle length (CL) was 465 ms and QRS morphology was LBBB+LAD. Even after nifekalant administration, VT storm was uncontrollable. Frequent cardioversion and sedation were needed. After d-sotalol administration, cathether ablation was performed with electro-anatomical mapping (CARTO). The substrate map of RV revealed low voltage zone in anterior wall and RVOT. VT was inducted easily with programmed stimulations at RVA and RVOT, so this VT’s mechanism thought to be reentry. But the centrifugal electric potential from RVOT anterior wall was confirmed in activation map. The CL on activation map was covered only 200 ms, the reentry circuits may be located in the epicardium. The earliest ventricular activation site was 100 ms prior to the QRS onset on endocardium at RVOT. Radiofrequency energy was delivered around this site and linear ablation was performed in low voltage zone between tricuspid annulus and anterior wall. Finally, clinical VT couldn’t be inducted by programmed stimulation and didn’t occurred during follow up period. In this case, VT origin may present at RV epicardium which was controlled with ablation and d-sotalol.