Invasive electrophysiology Ablation of a catecholaminergic polymorphic VT and VF originating from Purkinje fibers – a case report

Abstract

We describe a case of a 25-year-old woman suffering from recurrent adrenergic polymorphic ventricular tachycardia (PVT). As a 14-year-old the patient suffered from recurrent episodes of syncope during exercise or emotion. On Holter monitoring unsustained runs of PVT were observed. The patient survived SCD (VF) which occurred near the hospital. An ICD was implanted and during the first year over 150 adequate discharges were present. During 9 year follow-up the patient had to have 4 ICDs replaced. She suffered from post-traumatic stress disorder syndrome due to frequent ICD shocks. After age of 23 she was admitted to our hospital and an ablation using the CARTO system was performed. No low voltage areas were observed. During the study ventricular premature beats and VT/PVT runs were observed originating from the Purkinje fibres. RF applications were delivered at those sites, during which abrupt PVT runs were present. After the ablation no ventricular arrhythmia was registered in the ICD memory during 2-year follow-up.