Catheter Ablation of Ischemic Ventricular Tachycardia Originating from an Inferobasal Right Ventricular Scar Using Substrate Mapping: A Case Report

Catheter ablation of ventricular tachycardia (VT) has emerged as a superior alternative to antiarrhythmic drug therapy in patients with ischemic cardiomyopathy, with the vast majority of ischemic VT being ablation from the endocardial surface of the left ventricle (LV). While rare, the possibility of ischemic right ventricular (RV) VT should also be entertained, especially in patients with previous myocardial infarction and in those individuals in whom LV endocardial ablation fails to abolish VT. Further, success rates remain disappointing in some of these cases, often owing to difficulties in mapping the tachycardia due to hemodynamic instability during VT. We report a case of hemodynamically unstable ischemic VT successfully ablated from the endocardial surface of the LV and RV using a substrate mapping approach in a patient with a large inferior myocardial infarction, involving RV infarction.